本文選題：纖維支氣管鏡　切入點(diǎn)：支氣管結(jié)核　出處：《天津醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：支氣管結(jié)核(endobronchial tuberculosis, EBTB),是指發(fā)生在氣管、支氣管黏膜、黏膜下層和外膜(軟骨和纖維組織)的結(jié)核病,既往亦曾稱(chēng)為“支氣管內(nèi)膜結(jié)核”�；顒�(dòng)性肺結(jié)核中大約10%～40%伴有EBTB。一般認(rèn)為女性發(fā)病是男性的2-3倍,中青年發(fā)病更常見(jiàn),但老年EBTB有增加趨勢(shì)。主支氣管、兩肺上葉、右肺中葉、左肺上葉舌段支氣管為好發(fā)部位。成人EBTB最常見(jiàn)的感染途徑是肺內(nèi)病灶中結(jié)核分支桿菌直接植入支氣管黏膜。近年來(lái)隨著纖維支氣管鏡應(yīng)用的普及以及醫(yī)務(wù)人員對(duì)EBTB認(rèn)知度的提高,EBTB患者的確診率逐步提高。但在常規(guī)抗結(jié)核治療過(guò)程中患者臨床癥狀緩解及痰菌陰轉(zhuǎn)慢,受累支氣管易發(fā)生不同程度狹窄甚至導(dǎo)致嚴(yán)重肺不張,重者需要手術(shù)治療,因此在常規(guī)治療基礎(chǔ)上需對(duì)EBTB患者進(jìn)行積極干預(yù)。在本臨床研究中選取潰瘍壞死型EBTB(即纖維支氣管鏡下結(jié)核病變明顯期)患者做為研究對(duì)象,探討在全身化療基礎(chǔ)上進(jìn)一步通過(guò)纖維支氣管鏡對(duì)病變氣管進(jìn)行介入治療的療效評(píng)估。 目的：評(píng)價(jià)在全身化療(肺外結(jié)核化療方案)基礎(chǔ)上經(jīng)纖維支氣管鏡局部注藥治療潰瘍壞死型支氣管結(jié)核的療效。方法：選取經(jīng)纖維支氣管鏡檢查確診的初次抗結(jié)核治療的潰瘍壞死型支氣管結(jié)核45例,分為介入治療組及基礎(chǔ)治療組,觀察期為6個(gè)月。兩組患者入組時(shí)需完善血、尿常規(guī)、肝腎功能、胸片、胸部CT及痰抗酸染色檢查,無(wú)肝腎功能異常,此后前2月每半月復(fù)查血生化、胸部影像學(xué)及痰抗酸染色,后4月每月復(fù)查一次上述檢查。兩組患者觀察期內(nèi)化療方案為2HRZE/4HR (INH0.3QD, RFP0.45QD, EMB0.75QD, PZA0.5TID)及霧化吸入抗癆藥物治療(NS20ML+1NH0.1+Amikacin0.2QD),觀察期結(jié)束后繼續(xù)鞏固抗結(jié)核治療。介入治療組采用Olympus BF-1T30型纖維支氣管鏡及配套毛刷、活檢鉗、注藥管,術(shù)前準(zhǔn)備、局麻、操作步驟按纖支鏡臨床操作指南進(jìn)行。具體操作為在氣管鏡直視下將氣管內(nèi)分泌物充分吸引、并應(yīng)用活檢鉗鉗取干酪壞死物質(zhì)后局部注入抗癆藥物凝膠(含INH、RFP、SM,若SM過(guò)敏可單獨(dú)配藥),每2周1次,根據(jù)病情好轉(zhuǎn)情況停止注藥。具體停止注藥時(shí)機(jī)掌握為氣管內(nèi)干酪壞死物消失、痰抗酸染色檢查連續(xù)2次陰性,至觀察結(jié)束治療組患者共計(jì)行3-7次纖支鏡治療。結(jié)果：介入治療組患者臨床癥狀緩解(平均16.2天)、痰菌陰轉(zhuǎn)(平均25.3天)及胸部影像學(xué)好轉(zhuǎn)(平均15.4天)均優(yōu)于基礎(chǔ)治療組。介入治療組中有21例患者入組時(shí)存在不同程度支氣管狹窄,至觀察結(jié)束支氣管內(nèi)干酪壞死物已消失,19例氣管狹窄減輕,2例病變氣管形成肉芽腫、狹窄較前加重�；A(chǔ)治療組患者16例患者入組時(shí)存在不同程度支氣管狹窄,至觀察結(jié)束氣管內(nèi)干酪壞死物亦消失,僅有8例氣管狹窄減輕,5例病變氣管形成肉芽腫、狹窄較前加重,2例變化不大。結(jié)論：經(jīng)纖維支氣管鏡局部注藥治療潰瘍壞死型支氣管結(jié)核,使患者臨床癥狀緩解加快,加速痰菌陰轉(zhuǎn),減輕支氣管狹窄,促進(jìn)肺不張的復(fù)張,改善預(yù)后。
[Abstract]:Bronchial tuberculosis (endobronchial tuberculosis, EBTB), refers to the place in the trachea, bronchial mucosa, submucosa and tunica adventitia (cartilage and fibrous tissue) of tuberculosis, also known as the "history of endobronchial tuberculosis. Active pulmonary tuberculosis in about 10% ~ 40% with EBTB. is generally considered that the female incidence is 2-3 times that of men, in young onset is more common, but the old EBTB has an increasing trend. The main bronchus, two upper lobe, right middle lobe, left lung lingual lobe bronchus is the predilection sites of infection. The most common way of adult EBTB tuberculosis pulmonary lesions in branch coli directly into the bronchial mucosa. In recent years, with the popularity of the application of fiberoptic bronchoscopy. The medical personnel and improve awareness of EBTB, EBTB patients'diagnosis rate is gradually increased. But in the conventional process of anti tuberculosis treatment in patients with clinical symptoms and the sputum conversion is slow, not prone to bronchial involvement With the degree of stenosis and even cause severe atelectasis, or need surgery, therefore, on the basis of routine treatment for active intervention in patients with EBTB. Select the ulcer necrosis type EBTB in this clinical study (i.e. bronchoscopic tuberculosis lesions period) patients as the research object, discussed further on the basis of systemic chemotherapy through fiberoptic bronchoscopy to evaluate the effect of interventional therapy on lesions of the trachea.
Objective: To evaluate the systemic chemotherapy (pulmonary tuberculosis chemotherapy) on the basis of transbronchial treatment of local injection of necrotizing ulcerative endobronchial tuberculosis patients. Methods: 45 cases of ulcer necrosis endobronchial tuberculosis by fiberoptic bronchoscopy confirmed the initial anti tuberculosis treatment, divided into treatment group and treatment group. The observation period was 6 months. The two groups were enrolled to improve the blood, urine routine, liver and kidney function, chest X-ray, chest CT and sputum acid fast staining, no liver and kidney dysfunction, since before the February fortnightly review of blood biochemical, radiological and sputum acid fast staining, after a review of the April monthly check. Two groups of patients in the observation period of chemotherapy for 2HRZE/4HR (INH0.3QD, RFP0.45QD, EMB0.75QD, PZA0.5TID) and inhalation of anti tuberculosis drugs (NS20ML+1NH0.1+Amikacin0.2QD), after the end of the observation period to continue to consolidate the anti tuberculosis treatment. The dielectric In the treatment group were treated with Olympus BF-1T30 type of fiberoptic bronchoscopy and biopsy forceps, brush supporting, injection tube, preoperative preparation, anesthesia, operation step by bronchoscopy clinical practice guidelines. The specific operation is in the bronchoscope under direct vision tracheal secretions to attract, and the application of anti tuberculosis drugs injected gel biopsy forceps after taking the cheese necrotic material (including INH, RFP, SM, SM if allergies can separate dispensing), 1 times every 2 weeks, according to the condition improved. Stop injection stop injection timing specific disappeared endotracheal cheese necrosis, sputum acid fast staining examination of 2 consecutive negative, to the end of the observation group a total of 3-7 patients underwent bronchoscopy treatment. Results: the treatment group clinical symptoms (average 16.2 days), sputum conversion (average 25.3 days) and chest imaging improvement (mean 15.4 days) were better than the control group. Intervention group of 21 patients in When there are different degrees of bronchial stenosis, to observe the end of endobronchial cheese necrosis has disappeared, 19 cases of tracheal stenosis reduced, 2 cases of tracheal granuloma formation, stenosis were worse than before. The basic treatment of 16 cases of all patients have different degrees of bronchial stenosis group, to observe the end of endotracheal cheese necrosis also disappeared. Only 8 cases of tracheal stenosis reduced, 5 cases of tracheal granuloma formation, 2 cases of stenosis were worse than before, little change. Conclusion: fiberoptic bronchoscopy in treatment of local injection of necrotizing ulcerative type of bronchial tuberculosis in patients with clinical symptoms, accelerate, accelerate sputum conversion, relieve bronchial stenosis, promote atelectasis reexpansion and improve the prognosis.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R521.2

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