摘要
目的:探讨超细电子支气管镜在气管支气管结核精准诊疗中的应用价值。方法:采用回顾性研究方法,收集南京市第二医院2017年7月至2020年7月经常规支气管镜未诊断但经超细支气管镜诊断的气管支气管结核患者33例作为病例组,对同期入院的经常规支气管镜诊断气管支气管结核患者以相同年龄、性别为配对原则随机选择66例作为对照组,采用 χ2检验比较2组患者的病原学检出率及直视观察气管支气管病变阳性率。并对病例组患者的临床症状、影像表现、气管镜下表现及治疗转归进行描述性分析。 结果:对照组患者0~4级支气管镜下表现符合气管支气管结核镜下诊断标准,病例组不符合,但病例组5~10级支气管镜下表现符合该病镜下诊断标准。病例组病原学检出率(75.76%,25/33)与对照组(78.79%,52/66)比较差异无统计学意义( χ2=0.117, P>0.05)。病例组患者以咳嗽(90.91%,30/33)、咳痰(60.61%,20/33)为常见临床症状;结节影(84.85%,28/33)为常见影像表现;Ⅳ型(瘢痕狭窄型)(51.52%,17/33)为常见气管镜下分型;病变好发部位:上叶尖后段>背段>舌段/中叶>基底段。 结论:超细支气管镜检查可提高气管支气管结核的病变诊断阳性率,但不能提高气管支气管结核的病原学检测阳性率。若影像学符合气管支气管结核常见表现,但常规支气管镜检查无明显异常,可换用超细支气管镜检查,提高气管支气管结核的检出率。
Objective To investigate the value of ultrathin bronchoscopy in the accurate diagnosis of tracheobronehial tuberculosis(TBTB).Methods In a retrospective study,33 patients with TBTB diagnosed by ultrathin bronchoscopy from July 2017 to July 2020 in the Second Hospital of Nanjing were selected as the case group.According to the 1∶2 matching principle,66 patients of the same age and gender diagnosed by conventional bronchoscopy in the same period were selected as the control group.The Chi-square test was used to compare the etiological detection rate and the positive rate of tracheobronchial lesions observed by direct vision between the two groups.The clinical data,imaging and tracheal findings,treatment outcome of patients in the case group were collected for descriptive analysis.Results The manifestations of 0-4 grade bronchus in the control group were consistent with the diagnostic criteria of TBTB,but not in the case group.However,the manifestations of 5-10 grade bronchus in the case group were consistent with the diagnostic criteria.There was no statistical significance in the etiological detection rate between the case group and the control group[75.76%(25/33)vs 78.79%(52/66),χ2=0.117,P>0.05].In the case group,cough(90.91%,30/33)and expectoration(60.61%,20/33)were common clinical symptoms,nodular shadow(84.85%,28/33)was common imaging finding,typeⅣ(cicatricial stenosis type)(51.52%,17/33)was common tracheal classification,lesion predilection sites:posterior segment of upper lobe>lower lobe dorsal segment>lingual segment/middle lobe>basal segment of lower lobe.Conclusions Ultrathin bronchoscopy can improve the positive rate of tracheobronchial lesions observed by bronchoscopy in bronchial tuberculosis,but it cannot improve the etiological detection rate of bronchial tuberculosis.If the imaging findings are consistent with the common imaging findings of TBTB,but routine bronchoscopy is not significantly abnormal,ultrathin bronchoscopy can be used instead to achieve the accuracy of the diagnosis of TBTB.
作者
郭晶
林霏申
费贤树
王丹
曹志云
张侠
Guo Jing;Lin Feishen;Fei Xianshu;Wang Dan;Cao Zhiyun;Zhang Xia(Department of Tuberculosis,the Second Hospital of Nanjing,Nanjing University of Chinese Medicine,Nanjing 211131,China)
出处
《国际呼吸杂志》
2021年第3期185-190,共6页
International Journal of Respiration
