纤支镜术及其肺泡灌洗术在儿童疑难肺结核的诊断应用

发布时间：2018-10-21 09:47

【摘要】：目的：探讨纤支镜术及其肺泡灌洗术在儿童疑难肺结核的诊断应用及临床价值。方法：收集2008年1月-2011年12月收入重庆医科大学附属儿童医院疑诊儿童肺结核527例，对其中病原学阴性、诊断疑难的67例行纤支镜术及其肺泡灌洗术，结合临床资料、影像学表现，分析疑难肺结核患儿纤支镜下特点及纤支镜术后结核分支杆菌检出率对辅助诊断的价值。结果：经纤支镜术及其肺泡灌洗术后，结合临床资料、影像学表现，确诊疑难肺结核35例（52.2%），除外肺结核22例（32.8%）。儿童疑难肺结核临床表现不典型，以原发型肺结核多见（54.3%），34.3%合并支气管内膜结核。纤支镜下特点为管外压迫（42.9%）、赘生物（25.7%）、干酪样物质（20.0%）及分泌物阻塞（17.1%）所致支气管开口狭窄最多见。支气管肺泡灌洗液(BALF)、术后痰和（或）胃液检测共检出结核分支杆菌31例（88.6%），以灌洗液行结核杆菌聚合酶链反应（MTB-PCR）阳性率（57.1%）最高，4例（11.4%）行支气管内膜病理活检确诊。结论：纤支镜术及其肺泡灌洗术可显著提高儿童疑难肺结核的诊断率及结核杆菌检出率，尤其是支气管内膜结核。目的：探讨12例儿童疑难支气管结核的临床特征及支气管镜对其诊疗价值。方法：对2008年1月-2011年12月收入重庆医科大学附属儿童医院的35例疑难肺结核患儿行支气管镜检查以辅助诊断，帮助确诊疑难支气管结核12例，将其检查发现，结合病史、临床表现、影像学及实验室资料进行分析总结。结果： 12例疑难支气管结核患儿临床症状多样，主要为咳嗽伴发热，可有持续性喘息、活动后气促等，咯血少见；影像学表现主要为肺门和（或）纵隔淋巴结肿大，阻塞性肺气肿、肺不张发生率较其他类型肺结核高，胸部增强CT比胸片的诊断价值更大；纤支镜直观表现以肉芽组织、赘生物增生、干酪样坏死及管外压迫为主，灌洗液结核菌阳性6例（50%），4例经支气管镜行内膜活检确诊，2例在纤支镜检查后胃液涂片找到结核菌。结论：儿童疑难支气管结核临床表现多样，，支气管镜直观检查、肺泡灌洗术、内膜病理活检对儿童疑难支气管结核的诊断及病理分型均有重要作用。
[Abstract]:Objective: to investigate the diagnostic value of bronchofiberscope and alveolar lavage in children with difficult pulmonary tuberculosis. Methods: from January 2008 to December 2011, 527 cases of suspected pulmonary tuberculosis were collected from the Children's Hospital affiliated to Chongqing Medical University. Among them, 67 cases with negative etiology and difficult diagnosis were treated with fiberoptic bronchoscopy and alveolar lavage. Combined with clinical data and imaging findings, the characteristics of mycobacterium tuberculosis in children with difficult pulmonary tuberculosis and the diagnostic value of Mycobacterium tuberculosis after fiberoptic bronchoscopy were analyzed. Results: after fiberoptic bronchoscopy and alveolar lavage, 35 cases (52.2%) were diagnosed as difficult pulmonary tuberculosis, 22 cases (32.8%) were excluded. Primary pulmonary tuberculosis (54.3%) and endobronchial tuberculosis (34.3%) were the most common clinical manifestations of difficult pulmonary tuberculosis in children. Under fiberoptic bronchoscopy, the stricture of bronchial orifice caused by external compression (42.9%), vegetative matter (25.7%), caseous substance (20.0%) and secretion obstruction (17.1%) was the most common. Mycobacterium tuberculosis was detected in 31 cases (88.6%) in sputum and / or gastric juice after bronchoalveolar lavage fluid (BALF),) operation. The positive rate of Mycobacterium tuberculosis in lavage fluid was 57.1% (57.1%) and confirmed by endobronchial biopsy in 4 cases (11.4%). Conclusion: bronchofiberscope and alveolar lavage can significantly improve the diagnostic rate and the detection rate of tuberculosis bacilli especially endobronchial tuberculosis in children. Objective: to investigate the clinical features of 12 children with difficult bronchial tuberculosis and the value of bronchoscopy in diagnosis and treatment. Methods: from January 2008 to December 2011, 35 children with difficult pulmonary tuberculosis admitted to the affiliated Children's Hospital of Chongqing Medical University were examined by bronchoscopy to help diagnose 12 cases of difficult bronchial tuberculosis. Combined with the history, clinical manifestations, imaging and laboratory data were analyzed and summarized. Results: the clinical symptoms of 12 children with difficult bronchial tuberculosis were various, mainly cough with fever, persistent wheezing, shortness of breath after movement, rare hemoptysis, and the main imaging manifestations were enlarged hilar lung and / or mediastinal lymph nodes. The incidence of obstructive emphysema and atelectasis was higher than that of other types of pulmonary tuberculosis. The diagnostic value of chest enhanced CT was higher than that of chest radiography. Mycobacterium tuberculosis was positive in 6 cases (50%) in lavage fluid, 4 cases were confirmed by endoscopy under bronchoscopy, and 2 cases were found in gastric juice smear after fiberoptic bronchoscopy. Conclusion: the clinical manifestations of difficult bronchial tuberculosis in children are various, the visual examination of bronchoscopy, alveolar lavage and endometrial biopsy are important for the diagnosis and pathological classification of children with difficult bronchial tuberculosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

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