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为了评估骨髓移植术后肺部弥漫性病变诊断中纤维支气管镜检(fibroptic bronchoscopy,FB)的应用价值,对2003年11月-2006年3月间18例骨髓移植术后出现肺部弥漫性病变、短期经验治疗效果欠佳的患者行FB,并做支气管肺泡灌洗(BAL)及刷检涂片,其中3例条件许可者加支气管镜肺活检(TBLB)。结果发现,18例骨髓移植术后患者10例为肺部感染,8例为非感染性肺部并发症。10例肺部感染患者9例通过FB明确诊断,包括细菌性肺炎3例,真菌感染2例,卡氏肺囊虫3例,病毒性肺炎1例。1例接受2次BAL,无阳性结果,开胸肺活检确诊为结核。8例非感染性肺部并发症患者中2例通过TBLB明确诊断。结论:FB特别是BAL是一种安全、有效的检查方法,对白血病骨髓移植后肺部并发症尤其感染性肺部并发症的诊断率高;条件许可者应尽可能行TBLB,以提高移植后非感染并发症诊断,减少开胸肺活检。
In order to evaluate the value of fibrobronchoscopy (FB) in the diagnosis of diffuse lung lesions after bone marrow transplantation, diffuse lesions of the lungs were observed in 18 patients after bone marrow transplantation between November 2003 and March 2006 , Short-term experience of poor treatment of patients with FB, and do bronchoalveolar lavage (BAL) and brush test smear, including 3 cases of conditional permit bronchoscopy lung biopsy (TBLB). The results showed that in 18 patients after bone marrow transplantation in 10 cases of lung infection, 8 cases of non-infectious pulmonary complications. Nine of 10 patients with pulmonary infection were confirmed by FB, including 3 cases of bacterial pneumonia, 2 cases of fungal infection, 3 cases of Pneumocystis carinii and 1 case of viral pneumonia. One case received 2 BAL, no positive results, open lung biopsy confirmed tuberculosis. Two of eight patients with noninfectious pulmonary complications were diagnosed by TBLB. CONCLUSION: FB, especially BAL, is a safe and effective method for the diagnosis of pulmonary complications, especially infectious pulmonary complications, following leukemia bone marrow transplantation. Patients with conditions permit should be treated with TBLB as much as possible to improve post-transplantation Diagnosis of noninfectious complications and reduction of open lung biopsy.