纤维支气管镜对支气管结核的诊治价值(1)
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【摘要】 目的 探讨和评价纤维支气管镜在支气管结核早期诊断及治疗中的价值。方法 分析54例支气管结核患者的纤维支气管镜下表现及经纤维支气管镜局部灌注抗结核药治疗气管结核。结果 纤维支气管镜表现：炎性侵润型22.22%，溃疡型51.85%，增殖型(包括瘢痕狭窄)25.92%。治疗结果，51例菌阳患者全部转阴，纤维支气管镜所见病灶完全吸收或明显吸收、管腔通畅，总有效率为100%。结论 支气管结核临床及X线、CT表现特异性不强，纤维支气管镜检查为支气管结核早期诊断的主要措施，且经纤维支气管镜局部灌注抗结核药治疗支气管结核疗效显著、副作用少、安全可靠，值得广泛推广应用。
【关键词】 支气管结核；局部灌注；治疗；纤维支气管镜
Bronchofibroscope’s application Value in the diagnosis and treatment of trachea-bronchial tuberculosis
PIAO Fan-zhu, et al.
Department of Respiration internal medicine, The Tumor Hospital ofYanbian,Yanji Jilin 133000, China
【Abstract】 Objective To observe and evaluate the efficacy in the diagnosis and treatment of trachea-bronchial tuberculosis with flexible bronchoscope. Methods 54 bronchial tuberculosis patients were treated with local injected anti-tuberculosis drugs through flexible bronchoscope, in which 51 positive-tuberculosis patients become negative and lesions on bronchi were partly or completely absorbed. Total effective rate was 100%.And on the appearance of trachea-bronchial tuberculosis under flexible bronchoscope were investigated. Results There were 22.22% of infiltration, 51.85% of ulcerating form,5.92% of proliferation including scary narrow respectively on the appearance of flexible bronchoscope.Conclusion The interventional treatments with local injected anti-tuberculosis drugs though flexible bronchoscope to bronchial tuberculosis are minimally invasive, safe andeffective, which may be the first choice in the treatment to bronchial tuberculosis.
【Key words】 Trachea and bronchial tuberculosis; Local injected anti-tuberculosis; Therapy; Fibrotic bronchoscope
气管、支气管结核是发生在气管、支气管黏膜或黏膜下层乃至浆膜的结核病[1，2]。可继发于活动性肺结核，特别是空洞性肺结核，也可肺内无明显结核病灶而由支气管淋巴结核破溃到气管、支气管所致。据统计肺结核患者约60%合并支气管结核，但患者缺乏特异性临床表现，易误诊或漏诊。纤维支气管镜应用于临床后给支气管结核的诊断和治疗提供了有力的依据和方法。我院于2005年7月~2010年7月经纤维支气管镜刷检及活检确诊支气管结核54例，并纤维支气管镜下局部灌注抗结核药给予治疗。本文通过分析探讨和评价纤支镜在支气管结核的诊断与治疗中的价值。现分析如下。
1 资料与方法
1.1 一般资料 54例中，男24例 女30例，年龄18~61岁，病程2~18个月。伴随继发型肺结核的31例，颈部淋巴结核2例，肺内无明显结核病灶者23例。X线、CT示右肺上叶不张着12例，左肺上叶不张这14例，左肺下叶不张者10例，支气管狭窄无肺不张者23例。
1.2 临床表现 发热36例(66.67%)，咳嗽51例(94.44%)，咳痰42例(77.78%)，咯血16例(29.63%)，气喘34例(62.96%)，胸痛12例(22.22%)，部分患者伴有消瘦、乏力、盗汗、食欲不振等症状。
1.3 方法
1.3.1 检查方法 术前常规检查心电图、凝血功能等 ......
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