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目的探讨纤支镜检查技术对菌阴性肺结核的诊断价值。方法通过回顾性分析153例痰涂片、痰培养和PCR分析均为结核杆菌阴性疑诊为肺结核最终确诊为肺结核的患者病例资料。观察肺结核病灶在纤支镜下的表现,并于镜下行组织活检、刷检、组织盲检,支气管肺泡灌洗液涂片及PCR检查和痰结核分枝杆菌涂片检查。结果回顾性分析发现肺结核纤支镜下改变主要为粘膜充血肿胀(23.5%)、粘膜溃疡糜烂(19.6%)、粘膜表面灰白色苔状物或豆腐渣样物质覆盖(15.7%)和支气管瘢痕或狭窄(13.1%)。纤支镜下组织活检、刷检、组织盲检,支气管肺泡灌洗液涂片及PCR检查和痰结核分枝杆菌涂片检查,诊断为肺结核的患者占最终明确诊断为肺结核的百分比分别为41.2%(63/153),47.1%(72/153),11.1%(17/153),56.9%(87/153),55.6%(85/153)和32.0%(49/153)。结论菌阴性肺结核镜下改变多样无特征性,纤支镜检查技术对菌阴性肺结核的明确诊断具有重要价值,多种纤支镜技术联合能够明显提高菌阴性肺结核的诊断率。
Objective To investigate the diagnostic value of fiberoptic bronchoscopy on bacteriostatic pulmonary tuberculosis. Methods A retrospective analysis of 153 cases of sputum smear, sputum culture and PCR analysis were negative for mycobacterium tuberculosis suspected tuberculosis patients eventually diagnosed as pulmonary tuberculosis patients. Observe the performance of pulmonary tuberculosis under bronchoscopy, and under the microscope biopsy, brush test, blind tissue, bronchoalveolar lavage fluid smear and PCR and sputum Mycobacterium tuberculosis smear. Results Retrospective analysis showed that the pathological changes of bronchiectasis were mainly mucosal swelling and swelling (23.5%), mucosal ulcer erosion (19.6%), gray mucilage or rubbish-like substance covering mucosal surface (15.7%) and bronchial scar or stenosis (13.1%). Fiberoptic bronchoscopy biopsy, brush test, blind tissue, bronchoalveolar lavage fluid smear and PCR and sputum Mycobacterium tuberculosis smear examination, the diagnosis of tuberculosis patients accounted for the final diagnosis of tuberculosis were the final percentage were 41.2 % (63/153), 47.1% (72/153), 11.1% (17/153), 56.9% (87/153), 55.6% (85/153) and 32.0% (49/153). CONCLUSIONS: Bacterial-negative pulmonary tuberculosis is diverse and varied without any characteristic. Fiberoptic bronchoscopy is of great value in the definitive diagnosis of bacterial-negative pulmonary tuberculosis. The combination of various bronchoscopy techniques can significantly improve the diagnostic rate of bacterial-negative pulmonary tuberculosis.