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目的探讨气管、支气管结核的误诊原因及其早期正确诊断的方法。方法回顾性分析150例被误诊的气管、支气管结核患者的临床资料、误诊原因和诊断方法。结果临床症状缺乏特征性,以刺激性干咳为主(75.0%),其次为间断性咯血、发热、胸闷、气促等,结核中毒表现不明显或缺如;临床影像学无典型性,可表现为正常、斑片状阴影、肺不张、阻塞性肺炎、肺门影增大和肺门肿块等;误诊疾病主要为肺癌并肺不张(49.0%)、肺炎(23.3%)和支气管炎(17.3%),其他依次为肺结核、支气管扩张症、结核性胸膜炎和哮喘等;支气管镜下表现为肉芽增殖型(36.7%)、炎症浸润型(28.0%)、溃疡坏死型(24.0%)、瘢痕狭窄型(11.3%)。病变部位以左肺(49.4%)多于右肺(37.2%),左支气管受累比例最大(22.7%),病变遍及所有叶段支气管;150例中经支气管镜活检诊断131例(87.3%),毛刷涂片抗酸染色细菌学诊断41例(27.3%)。结论气管、支气管结核在临床症状、影像学和结核菌痰检学方面缺乏特征性,极易误诊。误诊的主要原因是临床医师对该病认识不足和不重视或放弃支气管镜检查。支气管镜活检和刷检是目前诊断气管、支气管结核最可靠和最准确的方法,值得临床医师推广应用。
Objective To investigate the causes of misdiagnosis of trachea and bronchial tuberculosis and their early correct diagnosis. Methods A retrospective analysis of 150 cases of misdiagnosed tracheobronchial tuberculosis patients with clinical data, causes of misdiagnosis and diagnostic methods. The results of the clinical symptoms of the lack of characteristic, with predominant irritating cough (75.0%), followed by intermittent hemoptysis, fever, chest tightness, shortness of breath and so on, tuberculosis poisoning performance was not obvious or lack of clinical imaging without typical, can be manifested (49.0%), pneumonia (23.3%), and bronchitis (17.3%), with atelectasis, pulmonary atelectasis, obstructive pneumonia, %), Followed by tuberculosis, bronchiectasis, tuberculous pleurisy and asthma; bronchoscopy showed granuloma proliferation (36.7%), inflammatory infiltration (28.0%), ulcer necrosis (24.0%), scar stenosis Type (11.3%). Lesions included left lung (49.4%), right lung (37.2%), left bronchus (22.7%) and lesions in all leaf segments of the bronchus; 131 (87.3%) were diagnosed by bronchoscopy in 150 cases, 41 cases (27.3%) were diagnosed bacteriologically by anti-acid stain with brush smear. Conclusion Trachea and bronchial tuberculosis are not characterized in clinical symptoms, imaging and sputum smear of M. tuberculosis, and are easily misdiagnosed. The main reason for misdiagnosis is clinicians lack of knowledge of the disease and do not attach importance to or give up bronchoscopy. Bronchoscopy biopsy and brushing is the most reliable and accurate method for the diagnosis of the trachea and bronchial tuberculosis, which is worth popularization and application by clinicians.