【摘要】：目的： 探討纖支鏡術及其肺泡灌洗術在兒童疑難肺結核的診斷應用及臨床價值。 方法： 收集2008年1月-2011年12月收入重慶醫(yī)科大學附屬兒童醫(yī)院疑診兒童肺結核527例，對其中病原學陰性、診斷疑難的67例行纖支鏡術及其肺泡灌洗術，結合臨床資料、影像學表現，分析疑難肺結核患兒纖支鏡下特點及纖支鏡術后結核分支桿菌檢出率對輔助診斷的價值。 結果： 經纖支鏡術及其肺泡灌洗術后，結合臨床資料、影像學表現，確診疑難肺結核35例（52.2%），除外肺結核22例（32.8%）。兒童疑難肺結核臨床表現不典型，以原發(fā)型肺結核多見（54.3%），34.3%合并支氣管內膜結核。纖支鏡下特點為管外壓迫（42.9%）、贅生物（25.7%）、干酪樣物質（20.0%）及分泌物阻塞（17.1%）所致支氣管開口狹窄最多見。支氣管肺泡灌洗液(BALF)、術后痰和（或）胃液檢測共檢出結核分支桿菌31例（88.6%），以灌洗液行結核桿菌聚合酶鏈反應（MTB-PCR）陽性率（57.1%）最高，4例（11.4%）行支氣管內膜病理活檢確診。 結論： 纖支鏡術及其肺泡灌洗術可顯著提高兒童疑難肺結核的診斷率及結核桿菌檢出率，尤其是支氣管內膜結核。 目的： 探討12例兒童疑難支氣管結核的臨床特征及支氣管鏡對其診療價值。 方法： 對2008年1月-2011年12月收入重慶醫(yī)科大學附屬兒童醫(yī)院的35例疑難肺結核患兒行支氣管鏡檢查以輔助診斷，幫助確診疑難支氣管結核12例，將其檢查發(fā)現，結合病史、臨床表現、影像學及實驗室資料進行分析總結。 結果： 12例疑難支氣管結核患兒臨床癥狀多樣，主要為咳嗽伴發(fā)熱，可有持續(xù)性喘息、活動后氣促等，咯血少見；影像學表現主要為肺門和（或）縱隔淋巴結腫大，阻塞性肺氣腫、肺不張發(fā)生率較其他類型肺結核高，胸部增強CT比胸片的診斷價值更大；纖支鏡直觀表現以肉芽組織、贅生物增生、干酪樣壞死及管外壓迫為主，灌洗液結核菌陽性6例（50%），4例經支氣管鏡行內膜活檢確診，2例在纖支鏡檢查后胃液涂片找到結核菌。 結論： 兒童疑難支氣管結核臨床表現多樣，，支氣管鏡直觀檢查、肺泡灌洗術、內膜病理活檢對兒童疑難支氣管結核的診斷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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R725.1

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