【作者】 贾文娟；

【导师】 彭丽萍；

【作者基本信息】 吉林大学 ， 临床医学， 2009， 硕士

【摘要】 支气管内膜结核(endobronchial tuberculosis,EBTB)是近年来随着肺结核的发生而逐渐被重视的一种疾病,后发现也可单独起病,病变早期常发生于粘膜及粘膜下层,症状不典型,不易引起注意,早期诊断率较低,严重影响人们的正常生活,如果不予以早期干预,病变蔓延,将造成气道狭窄、甚至阻塞,从而引起肺炎、肺不张等不良后果。为了尽早诊断此病,本文对2005年1月-2009年1月我院呼吸科44例经纤维支气管镜(fiberoptic bronchoscopy,FOB)诊断支气管内膜结核的病例进行了回顾性分析,结果显示支气管内膜结核多见于青年女性,症状多以咳嗽、咳痰为主,结核中毒症状不常见,易被误诊为肺炎、中央型肺癌、支气管哮喘、慢性阻塞性肺部疾病(chronic obstructive pulmonary disease,COPD)等。支气管内膜结核在肺高分辨率体层成像(High resolution computedtomography,HRCT)上常表现为受累支气管管壁增厚,管腔狭窄,伴或不伴有阻塞性肺炎、肺不张,常合并纵隔淋巴结肿大。纤维支气管镜能明显提高支气管内膜结核的诊断率,减少误诊率。EBTB支气管镜下可见四种病理表现:炎症浸润型;肉芽增殖型;纤维狭窄型;溃疡型。其中炎症浸润型最为常见。临床上对于咳嗽、咳痰时间较长,治疗效果不好者,应常规行纤维支气管镜检查,提高此病的诊断率,减少误诊。更多还原

【Abstract】 Objective:To explore the clinical case characteristic and diagnostic value of FOB for endobronchial tuberculosis.Materials and Method:44 EBTB inpatients diagnosed by FOB for pathology in our Respiration department between January 2005 and January 2009 were analyzed retrospectively,The age,gender,main symptom of 44 EBTB were Summarized.To analyze the admission diagnosis,which disease can be misdiagnosed easily and summarize respective characteristic,the reason of misdiagnosis.To analyze the manifestation of HRCT and FOB,especially summarize the characteristic of onset location and type under FOB.Result:There were 29 females and 15 males in 44 cases,with a mean age of 44.36±18.51.we divided them into three groups.There were 15 females between 15-44 years old,6 between 45-59 years old,5 in 60-74,2 in 75 and above.There were 8 males between 15-44 years old,4 between 45-59 years old, 1 in 60-74,2 in 75 and above.The pathogenesis is from 15d to 2y,with a mean pathogenesis of 157.38±131.38d.During 44 EBTB,18 of which were misdiagnosed for pneumonia,5 for COPD,2 for Asthma,10 for central lung cancer,1 for acute tracheobronchitis,2 for pulmonary tuberculosis,6 of which were firstly found atelectasis through imaging examination.The main symptom were cough 37(84.1%),expectoration 29(65.9%),wheezling13(29.5%),fever13 (29.5%),hemoptysis6(13.6%),chest pain7(15.9%),one(2.3%) was asymptomatic,only be found when he had health examination.During 44 EBTB,10 of them were firstly considered as central lung cancer, Three had tube obliteration,around by soft tissue shadow;Three had big hilar shadow,atelectasis of right middle lobe,lymphadenopathy;Two had atelectasis of left upper lobar,tube wall tickening,obliteration;Two were space occupying. 2 of 44 EBTB which were misdiagnosed as asthma initially only displayed spot flake shadow and mediastinal lymphadenectasis.16 were luminal stenosis,11 were tube wall thickening,3 were obliteration.There are 25 atelectasis.10 of 44 EBTB were complicated with lung tuberculosis.There were 67 focus of infection in all under FOB.17 of them have two trachea affection.Unilateral site and single position 27,unilateral site and more than one position 10,bilateral site and more than one position 3,4 were involved in main bronchus The distribution is as follows:main bronchus in 8, left main bronchus in11,left upper lobar bronchus in 10,left lower lobar bronchus in 9,right main bronchus in 8,right upper lobar bronchus in 6, right-middle lobar bronchus in 8,right-lower lobar bronchus in7.Most common manifestation under the bronchoscope is edematous-hyperemic in 25(56.8%), followed by fiber stenosis in 5(27.3%),granular proliferation in 12(11.4%), alcerative2(4.5%).Conclusion:EBTB occurs mainly in young female.Cough and expectation are the most common complains,EBTB has longer pathogenesis. EBTB often shows luminal stenosis,tube wall thickening and atelectasis or not under HRCT.EBTB is often complicated with pulmonary tuberculosis.The onset location of EBTB has nothing to do with left and right,upper,middle, lower lobar bronchus,mostly in unilateral site and single position Edematous-hyperemic is the most common type under FOB.The patients who have long-term cough and wheelzing repeatedly,bad therapeutic efficacy and atelecatasis should take FOB as conventional examination.It is very necessary to use fibrobronchoscope for final diagnosis.更多还原