44例经纤维支气管镜诊断支气管内膜结核的病例分析
|
摘要
支气管内膜结核(endobronchial tuberculosis,EBTB)是近年来随着肺结核的发生而逐渐被重视的一种疾病,后发现也可单独起病,病变早期常发生于粘膜及粘膜下层,症状不典型,不易引起注意,早期诊断率较低,严重影响人们的正常生活,如果不予以早期干预,病变蔓延,将造成气道狭窄、甚至阻塞,从而引起肺炎、肺不张等不良后果。为了尽早诊断此病,本文对2005年1月-2009年1月我院呼吸科44例经纤维支气管镜(fiberoptic bronchoscopy,FOB)诊断支气管内膜结核的病例进行了回顾性分析,结果显示支气管内膜结核多见于青年女性,症状多以咳嗽、咳痰为主,结核中毒症状不常见,易被误诊为肺炎、中央型肺癌、支气管哮喘、慢性阻塞性肺部疾病(chronic obstructive pulmonary disease,COPD)等。支气管内膜结核在肺高分辨率体层成像(High resolution computedtomography,HRCT)上常表现为受累支气管管壁增厚,管腔狭窄,伴或不伴有阻塞性肺炎、肺不张,常合并纵隔淋巴结肿大。纤维支气管镜能明显提高支气管内膜结核的诊断率,减少误诊率。EBTB支气管镜下可见四种病理表现:炎症浸润型;肉芽增殖型;纤维狭窄型;溃疡型。其中炎症浸润型最为常见。临床上对于咳嗽、咳痰时间较长,治疗效果不好者,应常规行纤维支气管镜检查,提高此病的诊断率,减少误诊。
Objective:To explore the clinical case characteristic and diagnostic value of FOB for endobronchial tuberculosis.
Materials and Method:44 EBTB inpatients diagnosed by FOB for pathology in our Respiration department between January 2005 and January 2009 were analyzed retrospectively,The age,gender,main symptom of 44 EBTB were Summarized.To analyze the admission diagnosis,which disease can be misdiagnosed easily and summarize respective characteristic,the reason of misdiagnosis.To analyze the manifestation of HRCT and FOB,especially summarize the characteristic of onset location and type under FOB.
Result:There were 29 females and 15 males in 44 cases,with a mean age of 44.36±18.51.we divided them into three groups.There were 15 females between 15-44 years old,6 between 45-59 years old,5 in 60-74,2 in 75 and above.There were 8 males between 15-44 years old,4 between 45-59 years old, 1 in 60-74,2 in 75 and above.The pathogenesis is from 15d to 2y,with a mean pathogenesis of 157.38±131.38d.During 44 EBTB,18 of which were misdiagnosed for pneumonia,5 for COPD,2 for Asthma,10 for central lung cancer,1 for acute tracheobronchitis,2 for pulmonary tuberculosis,6 of which were firstly found atelectasis through imaging examination.The main symptom were cough 37(84.1%),expectoration 29(65.9%),wheezling13(29.5%),fever13 (29.5%),hemoptysis6(13.6%),chest pain7(15.9%),one(2.3%) was asymptomatic,only be found when he had health examination.
During 44 EBTB,10 of them were firstly considered as central lung cancer, Three had tube obliteration,around by soft tissue shadow;Three had big hilar shadow,atelectasis of right middle lobe,lymphadenopathy;Two had atelectasis of left upper lobar,tube wall tickening,obliteration;Two were space occupying. 2 of 44 EBTB which were misdiagnosed as asthma initially only displayed spot flake shadow and mediastinal lymphadenectasis.16 were luminal stenosis,11 were tube wall thickening,3 were obliteration.There are 25 atelectasis.10 of 44 EBTB were complicated with lung tuberculosis.
There were 67 focus of infection in all under FOB.17 of them have two trachea affection.Unilateral site and single position 27,unilateral site and more than one position 10,bilateral site and more than one position 3,4 were involved in main bronchus The distribution is as follows:main bronchus in 8, left main bronchus in11,left upper lobar bronchus in 10,left lower lobar bronchus in 9,right main bronchus in 8,right upper lobar bronchus in 6, right-middle lobar bronchus in 8,right-lower lobar bronchus in7.Most common manifestation under the bronchoscope is edematous-hyperemic in 25(56.8%), followed by fiber stenosis in 5(27.3%),granular proliferation in 12(11.4%), alcerative2(4.5%).
Conclusion:EBTB occurs mainly in young female.Cough and expectation are the most common complains,EBTB has longer pathogenesis. EBTB often shows luminal stenosis,tube wall thickening and atelectasis or not under HRCT.EBTB is often complicated with pulmonary tuberculosis.The onset location of EBTB has nothing to do with left and right,upper,middle, lower lobar bronchus,mostly in unilateral site and single position Edematous-hyperemic is the most common type under FOB.The patients who have long-term cough and wheelzing repeatedly,bad therapeutic efficacy and atelecatasis should take FOB as conventional examination.It is very necessary to use fibrobronchoscope for final diagnosis.
Objective:To explore the clinical case characteristic and diagnostic value of FOB for endobronchial tuberculosis.
Materials and Method:44 EBTB inpatients diagnosed by FOB for pathology in our Respiration department between January 2005 and January 2009 were analyzed retrospectively,The age,gender,main symptom of 44 EBTB were Summarized.To analyze the admission diagnosis,which disease can be misdiagnosed easily and summarize respective characteristic,the reason of misdiagnosis.To analyze the manifestation of HRCT and FOB,especially summarize the characteristic of onset location and type under FOB.
Result:There were 29 females and 15 males in 44 cases,with a mean age of 44.36±18.51.we divided them into three groups.There were 15 females between 15-44 years old,6 between 45-59 years old,5 in 60-74,2 in 75 and above.There were 8 males between 15-44 years old,4 between 45-59 years old, 1 in 60-74,2 in 75 and above.The pathogenesis is from 15d to 2y,with a mean pathogenesis of 157.38±131.38d.During 44 EBTB,18 of which were misdiagnosed for pneumonia,5 for COPD,2 for Asthma,10 for central lung cancer,1 for acute tracheobronchitis,2 for pulmonary tuberculosis,6 of which were firstly found atelectasis through imaging examination.The main symptom were cough 37(84.1%),expectoration 29(65.9%),wheezling13(29.5%),fever13 (29.5%),hemoptysis6(13.6%),chest pain7(15.9%),one(2.3%) was asymptomatic,only be found when he had health examination.
During 44 EBTB,10 of them were firstly considered as central lung cancer, Three had tube obliteration,around by soft tissue shadow;Three had big hilar shadow,atelectasis of right middle lobe,lymphadenopathy;Two had atelectasis of left upper lobar,tube wall tickening,obliteration;Two were space occupying. 2 of 44 EBTB which were misdiagnosed as asthma initially only displayed spot flake shadow and mediastinal lymphadenectasis.16 were luminal stenosis,11 were tube wall thickening,3 were obliteration.There are 25 atelectasis.10 of 44 EBTB were complicated with lung tuberculosis.
There were 67 focus of infection in all under FOB.17 of them have two trachea affection.Unilateral site and single position 27,unilateral site and more than one position 10,bilateral site and more than one position 3,4 were involved in main bronchus The distribution is as follows:main bronchus in 8, left main bronchus in11,left upper lobar bronchus in 10,left lower lobar bronchus in 9,right main bronchus in 8,right upper lobar bronchus in 6, right-middle lobar bronchus in 8,right-lower lobar bronchus in7.Most common manifestation under the bronchoscope is edematous-hyperemic in 25(56.8%), followed by fiber stenosis in 5(27.3%),granular proliferation in 12(11.4%), alcerative2(4.5%).
Conclusion:EBTB occurs mainly in young female.Cough and expectation are the most common complains,EBTB has longer pathogenesis. EBTB often shows luminal stenosis,tube wall thickening and atelectasis or not under HRCT.EBTB is often complicated with pulmonary tuberculosis.The onset location of EBTB has nothing to do with left and right,upper,middle, lower lobar bronchus,mostly in unilateral site and single position Edematous-hyperemic is the most common type under FOB.The patients who have long-term cough and wheelzing repeatedly,bad therapeutic efficacy and atelecatasis should take FOB as conventional examination.It is very necessary to use fibrobronchoscope for final diagnosis.
引文
[1]孟要武,张丹,易锦发,等.单纯性支气管内膜结核的纤维支气管镜检查分析[J].第一军医大学学报,2005,25(5):591-592.
[2]范莉,张利诚,张明.等.支气管内膜结核临床特征及误诊原因[J].临床误诊误治,2007:20(7):47.
[3]关茂彬.浅谈支气管内膜结核的诊断及治疗[J].中外健康文摘,2008,5(8):70-71.
[4]Carriere C,Riska P,Zimhony O,et al.Conditional replicating Luciferase reporter phages:improved sensitivity for rapid detection and assessment of drug susceptibility of mycobacterium tuberculosis[J].Clin microb,1997,35(12):3232-3239.
[5]吕斌,徐顺清,符志军,等.利用重组分支杆菌噬菌体快速筛选耐利福平结核分支杆菌[J].中华结核和呼吸杂志,2000,23(6):480.
[6]中华医学会结核病学分会,中华结核和呼吸杂志编辑委员会.肺结核的诊断与鉴别诊断新进展学术研讨会会议纪要[J].中华结核和呼吸杂志,2001,24(7):397.
[7]谭守勇.肺结核的诊断与治疗进展[J].新医学,2006,37(4):266-268.
[8]Sarker G,Sommer SS.Shedding light on PCR contamination[J].Nature,1990,343:27-29
[9]施焕中,李超乾,龙学明,等.聚合酶链反应在诊断结核性胸腔积液中的应用[J].中华结核和呼吸杂志,1994,17:286-287
[10]张言斌,谭耀驹,谭守勇,等.聚合酶链反应用于涂阴结核早期诊断的评价[J].中华结核和呼吸杂志,1998,21:60.
[11]Plikaytis BB,Gelber PH,Shinnick TM,et al.Rapid and sensitive detection of M.Laprase using a nested primer gene amplification assay.[J]Clin Microbiol,1990,28:1913-1917.
[12]夏季,蔡晋,邓少丽,等.蛋白芯片联合检测5项结核抗体在结核病诊断中的价值[N].第三军医大学学报,2009,31(3):220-222.
[13]Demkow U,Ziolkowski J,FilewskaM,et al.Diagnostic value of different serological tests for tuberculosis in Poland[J].J Physiol Pharmacol,2004,55(Suppl3):57-66.
[14]Ravn P,MunkM E,Andersen A B,et al.Prospective evaluation of a whole blood test using Mycobacterium tuberculosis specific antigens ESAT 6 and CFP10 for diagnosis of active tuberculosis[J].Clin Diag Lab Immunol,2005,12(4):491-496.
[15]CHUNG HS,LEE JH1.Bronchoscopic assessment of the evolution of endobronchial tuberculosis[J].Chest,2000,117(2):385-392.
[16]刘付宗瑞,黄泽光.X线与CT扫描在诊断支气管内膜结核中的临床价值比较.[N]海南医学院学报,2008,14(4):372-374.
[17]Choe KO,Jeong HJ,Sohn HY.Tuberculous,Bronchial stenosis:CT finding in 28 cases[J].Am J Roentgenol,1990,155(5):971-976.
[18]朱晓华,邵江,尤正千,等.多层螺旋CT诊断支气管结核的价值[J].中华放射学杂志,2004,38(1):26-29.
[19]杨钧,周新华,马大庆.支气管结核的表现及动态观察[J].中国影像技术杂志,2002,18(5):248-250.
[20]韩英,马大庆,李铁一.多层螺旋CT多平面重建对支气管壁增厚的 诊断价值及临床应用[J].中华放射学杂志,2004,38(4):389-392.
[21]MOON WK,IM JG,YEON KM,et al.Tuberculosis of the central airway CT findings of active and fibrotic disease[J].AJR,1997,169(3):649-653.
[22]KIM Y H,LEE K S,YOON J H,et al.Tuberculosis of the trachea and main brouchi CT findings in 17 patients[J].AJR,1997,168(4):1051-1056.
[23]陈峰,郑凯尔,居胜红,等.CT仿真内镜临床应用的评价[J].临床放射学杂志,2000,19(1):14.
[24]黄信刚,王云华.等.螺旋CT仿真支气管镜与纤维支气管镜检查在较大气道病变诊断中的应用比较[J].中国内镜杂志,2005,11(1):27-29.
[25]郭凡,王仪生,李炎秋,等.CT仿真支气管内窥镜的临床应用观察[J].中华放射学杂志,1999,33:16-19.
[26]FLEITER T,M ER K LE EM,A SCH O FF AJ,et al.comparison of real-tim e virtual and Fiberopic bronchoscopy in patients with bronchial carcinoma al:opportunities and limitations[J].A JR,1997,169:1591-1595.
[27]刘含章,发源,华斌等,纤维支气管镜诊断支气管内膜结核47例分析[N].暨南大学学报,1997,18(4):17-20.
[28]陈品儒.气管支气管结核诊断治疗进展[J].临床荟萃,2005,20(8):478-480.
[29]姜红妮.气管-支气管结核诊断治疗进展[J].中国防痨杂志,2000,22(1):50-51.
[30]FANG X,MA B,YANG X.Bronchial tuberculosis.Cytologic diagnosis of fiberoptic bronchoscopic brushings[J].Acta Cytol,1997,41(5):1643-1667.
[31]Sardar SK.Fibroptic bronchoscopy in the diagnosis of pulmonary tuberculosis[J].Tubercle,1990,61:97-99.
[32]田敬伦,张福云.经支气管针吸活检对支气管结核的诊断价值[J].中国防痨杂志,2001,23(4):235-237.
[33]马路,苗灵娟,覃松石,等.巢式聚合酶链反应检测支气管内膜结核患者活检组织中结核杆菌DNA[J].中华结核和呼吸杂志,1999,22(3):145-146.
[34]Kurasawa T,Kuze F,Kawai M,et al.Diagnosis and management endobronchial tuberculosis[J].Intern Med,1992,31:593-598.
[35]徐胜辉,张胜男,纤支镜介入和雾化吸入治疗支气管内膜结核的疗效观察[N].国际医药卫生导报,2003,9(7):52.
[36]武广亭,支气管结核雾化及纤维支气管镜介入治疗疗效分析[J].中国现代医药杂志,2006,5(8):91.
[37]彭毅强,颜又新,窦冬英.经纤维支气管镜下局部注药治疗支气管内膜结核疗效分析[J].中国内镜杂志,1998,4(6):28.
[38]孙茂明,任风云,张霞.纤支镜导管介入治疗支气管内膜结核12例临床分析[J].中原医刊,2005,32:43.
[39]刘黎,汉香,张凤琴.经纤维支气管镜治疗各型支气管内膜结核的疗效观察[J].中华结核和呼吸杂志,2002,25:62.
[40]虞永鑫,王倩,张艳.经纤维支气管镜微波治疗支气管结核的疗效观察[J].临床荟萃,2007,22(8):580.
[41]燕真峰,高燕,张宇梅.等.微波治疗增殖型支气管内膜结核12例疗效观察[J].西北国防医学杂志,2007,28(1):68.
[42]周敏,贾友明,陈凤珠.等.经纤维支气管镜Nd:YAG激光治疗腔内完全阻塞的支气管结核[N].上海医科大学学报,1995,22:41-43.
[43]靖秋生,李彩萍,周静,等.经纤维支气管镜KTP激光治疗支气管结核的近期疗效观察[J].中国激光医学杂志,2004,13:78-80.
[44]Nakamura K.Terada N.Ohi M.Matsushita T,Kato Nakagawa T.Tuberculous bronchial stenosis:treatment with balloon bronchoplasty[J].AJR 1991,157:1187-1188.
[45]Hautmann H,Camarra F,Pfeifer KJ,et al.Fiberoptic bronchoscopic balloon dilatiation in malignant tracheobronchial disease:indications and results[J].Chest,2001,120:43-49.
[46]Chung HS,Han SK,Sim YS,et al.Balloon dilatation of bronchial stenosis in endonbronchial tuberculosis(in Korean)[J].Tuberculosis Respir Dis 1991,38:236-244.
[47]Wan I Y,Lee TW,Lam H C,et al.Tracheobronchial stenting for tuber2culous airway stenosis[J].Chest,2002,122(1):370-374.
[48]Schmidt B,Olze H,Borges A C,et al.Endotracheal balloon dilatation and stent implantation in benign stenoses [J].Ann Thorac Surg,2001,71(5):1630-1634.
[49]Lee JH,park SS,Lee DH,et al Endobrochial tuberculosis:clinical and bronchosc opic features in 121 cases [J].Chest 1992,102:990-994.
[50]Up,S Y,Hoon KS,Wook SJ.et al.The effect of steroid on the treatment of endobronchial tuberculosis [J].Tuber Respir Dis,1995.42(2):130-141.
[51]Urn,S-W;Yoon,YS;Lee,S-M;Yim,J-J;Yoo,C-G;Chung,H S;Kim,Y W;Han,SK;Shim,Y-S;Kim,DK Predictors of persistent airway stenosis in patients with endobronchial tuberculosis.Int [J]Tuberc Lung Dis,2008,12(1):57-62.
[1]朱余明,丁嘉安,高文.结核性气管支气管狭窄的外科治疗[J].中华结核和呼吸杂志,1998,21,(7):402-403.
[2]谢惠安,阳国太,林善梓,等.现代结核病学,北京:人民卫生出版社,2000,315-480。
[3]李先清,尹本义,瞿素洁.老年气管、支气管结核的纤支镜检查(附17例分析)[J].中国防痨杂志,1995,17(4):155-156.
[4]何礼贤,贾友明,李锡莹.从纤维支气管镜检查确诊的65例肺结核看肺结核与肺癌的鉴别诊断[J].中华结核和呼吸杂志,1991,14:2.
[5]王巍,王安生,庄玉辉.支气管结核诊断治疗近况[J]中华结核和呼吸杂志,2000,23(5):306-307.
[6]Kim Ho Cheol,Kim Hyeon Sik,Lee Seung Jun,et al.Endobronchial tuberculosis presenting as right middle lobe syndrome:clinical characteristics and bronchoscopic findings in 22 cases[J].Yonsei Med J,2008,49(4):615-9.
[7]陈小燕,丛丹丹,卫小红.等.容易误诊的支气管结核(附77例纤维支气管镜检查分析)[J].中国内镜杂志,1999,5(6):67-68.
[8]赵华,顾玉海,多杰.纤维支气管镜检查106例肺不张临床分析[J]中国内镜杂志,2008,14(11):1231-1232.
[9]MOON W K,IM J G,YEON KM,et al.Tuberculosis of the central airway CT findings of active and fibrotic disease[J].A JR,1997,169(3):649-653.
[10]Lee JH.Chung HS.Bronchoscopic,radiologic and pulmonary function evaluation of endobronchial tuberculosis[J].Respirology,2000,5:411-417.
[11]余文聘,容中生.支气管内膜结核90例临床分析[J].中华结核与呼吸杂志,1999,22:396-397
[12]王巍,李晓明.支气管肺泡灌洗液检查对痰涂阴性肺结核的诊断价值[J].中国防痨杂志,1995,17:171.
[13]Gracia JD,Curull V.Diagnostic value of bronchoqlveolar lavage in suspected pulmonary tuberculoa[J].Chest,1988,93:329.
[2]范莉,张利诚,张明.等.支气管内膜结核临床特征及误诊原因[J].临床误诊误治,2007:20(7):47.
[3]关茂彬.浅谈支气管内膜结核的诊断及治疗[J].中外健康文摘,2008,5(8):70-71.
[4]Carriere C,Riska P,Zimhony O,et al.Conditional replicating Luciferase reporter phages:improved sensitivity for rapid detection and assessment of drug susceptibility of mycobacterium tuberculosis[J].Clin microb,1997,35(12):3232-3239.
[5]吕斌,徐顺清,符志军,等.利用重组分支杆菌噬菌体快速筛选耐利福平结核分支杆菌[J].中华结核和呼吸杂志,2000,23(6):480.
[6]中华医学会结核病学分会,中华结核和呼吸杂志编辑委员会.肺结核的诊断与鉴别诊断新进展学术研讨会会议纪要[J].中华结核和呼吸杂志,2001,24(7):397.
[7]谭守勇.肺结核的诊断与治疗进展[J].新医学,2006,37(4):266-268.
[8]Sarker G,Sommer SS.Shedding light on PCR contamination[J].Nature,1990,343:27-29
[9]施焕中,李超乾,龙学明,等.聚合酶链反应在诊断结核性胸腔积液中的应用[J].中华结核和呼吸杂志,1994,17:286-287
[10]张言斌,谭耀驹,谭守勇,等.聚合酶链反应用于涂阴结核早期诊断的评价[J].中华结核和呼吸杂志,1998,21:60.
[11]Plikaytis BB,Gelber PH,Shinnick TM,et al.Rapid and sensitive detection of M.Laprase using a nested primer gene amplification assay.[J]Clin Microbiol,1990,28:1913-1917.
[12]夏季,蔡晋,邓少丽,等.蛋白芯片联合检测5项结核抗体在结核病诊断中的价值[N].第三军医大学学报,2009,31(3):220-222.
[13]Demkow U,Ziolkowski J,FilewskaM,et al.Diagnostic value of different serological tests for tuberculosis in Poland[J].J Physiol Pharmacol,2004,55(Suppl3):57-66.
[14]Ravn P,MunkM E,Andersen A B,et al.Prospective evaluation of a whole blood test using Mycobacterium tuberculosis specific antigens ESAT 6 and CFP10 for diagnosis of active tuberculosis[J].Clin Diag Lab Immunol,2005,12(4):491-496.
[15]CHUNG HS,LEE JH1.Bronchoscopic assessment of the evolution of endobronchial tuberculosis[J].Chest,2000,117(2):385-392.
[16]刘付宗瑞,黄泽光.X线与CT扫描在诊断支气管内膜结核中的临床价值比较.[N]海南医学院学报,2008,14(4):372-374.
[17]Choe KO,Jeong HJ,Sohn HY.Tuberculous,Bronchial stenosis:CT finding in 28 cases[J].Am J Roentgenol,1990,155(5):971-976.
[18]朱晓华,邵江,尤正千,等.多层螺旋CT诊断支气管结核的价值[J].中华放射学杂志,2004,38(1):26-29.
[19]杨钧,周新华,马大庆.支气管结核的表现及动态观察[J].中国影像技术杂志,2002,18(5):248-250.
[20]韩英,马大庆,李铁一.多层螺旋CT多平面重建对支气管壁增厚的 诊断价值及临床应用[J].中华放射学杂志,2004,38(4):389-392.
[21]MOON WK,IM JG,YEON KM,et al.Tuberculosis of the central airway CT findings of active and fibrotic disease[J].AJR,1997,169(3):649-653.
[22]KIM Y H,LEE K S,YOON J H,et al.Tuberculosis of the trachea and main brouchi CT findings in 17 patients[J].AJR,1997,168(4):1051-1056.
[23]陈峰,郑凯尔,居胜红,等.CT仿真内镜临床应用的评价[J].临床放射学杂志,2000,19(1):14.
[24]黄信刚,王云华.等.螺旋CT仿真支气管镜与纤维支气管镜检查在较大气道病变诊断中的应用比较[J].中国内镜杂志,2005,11(1):27-29.
[25]郭凡,王仪生,李炎秋,等.CT仿真支气管内窥镜的临床应用观察[J].中华放射学杂志,1999,33:16-19.
[26]FLEITER T,M ER K LE EM,A SCH O FF AJ,et al.comparison of real-tim e virtual and Fiberopic bronchoscopy in patients with bronchial carcinoma al:opportunities and limitations[J].A JR,1997,169:1591-1595.
[27]刘含章,发源,华斌等,纤维支气管镜诊断支气管内膜结核47例分析[N].暨南大学学报,1997,18(4):17-20.
[28]陈品儒.气管支气管结核诊断治疗进展[J].临床荟萃,2005,20(8):478-480.
[29]姜红妮.气管-支气管结核诊断治疗进展[J].中国防痨杂志,2000,22(1):50-51.
[30]FANG X,MA B,YANG X.Bronchial tuberculosis.Cytologic diagnosis of fiberoptic bronchoscopic brushings[J].Acta Cytol,1997,41(5):1643-1667.
[31]Sardar SK.Fibroptic bronchoscopy in the diagnosis of pulmonary tuberculosis[J].Tubercle,1990,61:97-99.
[32]田敬伦,张福云.经支气管针吸活检对支气管结核的诊断价值[J].中国防痨杂志,2001,23(4):235-237.
[33]马路,苗灵娟,覃松石,等.巢式聚合酶链反应检测支气管内膜结核患者活检组织中结核杆菌DNA[J].中华结核和呼吸杂志,1999,22(3):145-146.
[34]Kurasawa T,Kuze F,Kawai M,et al.Diagnosis and management endobronchial tuberculosis[J].Intern Med,1992,31:593-598.
[35]徐胜辉,张胜男,纤支镜介入和雾化吸入治疗支气管内膜结核的疗效观察[N].国际医药卫生导报,2003,9(7):52.
[36]武广亭,支气管结核雾化及纤维支气管镜介入治疗疗效分析[J].中国现代医药杂志,2006,5(8):91.
[37]彭毅强,颜又新,窦冬英.经纤维支气管镜下局部注药治疗支气管内膜结核疗效分析[J].中国内镜杂志,1998,4(6):28.
[38]孙茂明,任风云,张霞.纤支镜导管介入治疗支气管内膜结核12例临床分析[J].中原医刊,2005,32:43.
[39]刘黎,汉香,张凤琴.经纤维支气管镜治疗各型支气管内膜结核的疗效观察[J].中华结核和呼吸杂志,2002,25:62.
[40]虞永鑫,王倩,张艳.经纤维支气管镜微波治疗支气管结核的疗效观察[J].临床荟萃,2007,22(8):580.
[41]燕真峰,高燕,张宇梅.等.微波治疗增殖型支气管内膜结核12例疗效观察[J].西北国防医学杂志,2007,28(1):68.
[42]周敏,贾友明,陈凤珠.等.经纤维支气管镜Nd:YAG激光治疗腔内完全阻塞的支气管结核[N].上海医科大学学报,1995,22:41-43.
[43]靖秋生,李彩萍,周静,等.经纤维支气管镜KTP激光治疗支气管结核的近期疗效观察[J].中国激光医学杂志,2004,13:78-80.
[44]Nakamura K.Terada N.Ohi M.Matsushita T,Kato Nakagawa T.Tuberculous bronchial stenosis:treatment with balloon bronchoplasty[J].AJR 1991,157:1187-1188.
[45]Hautmann H,Camarra F,Pfeifer KJ,et al.Fiberoptic bronchoscopic balloon dilatiation in malignant tracheobronchial disease:indications and results[J].Chest,2001,120:43-49.
[46]Chung HS,Han SK,Sim YS,et al.Balloon dilatation of bronchial stenosis in endonbronchial tuberculosis(in Korean)[J].Tuberculosis Respir Dis 1991,38:236-244.
[47]Wan I Y,Lee TW,Lam H C,et al.Tracheobronchial stenting for tuber2culous airway stenosis[J].Chest,2002,122(1):370-374.
[48]Schmidt B,Olze H,Borges A C,et al.Endotracheal balloon dilatation and stent implantation in benign stenoses [J].Ann Thorac Surg,2001,71(5):1630-1634.
[49]Lee JH,park SS,Lee DH,et al Endobrochial tuberculosis:clinical and bronchosc opic features in 121 cases [J].Chest 1992,102:990-994.
[50]Up,S Y,Hoon KS,Wook SJ.et al.The effect of steroid on the treatment of endobronchial tuberculosis [J].Tuber Respir Dis,1995.42(2):130-141.
[51]Urn,S-W;Yoon,YS;Lee,S-M;Yim,J-J;Yoo,C-G;Chung,H S;Kim,Y W;Han,SK;Shim,Y-S;Kim,DK Predictors of persistent airway stenosis in patients with endobronchial tuberculosis.Int [J]Tuberc Lung Dis,2008,12(1):57-62.
[1]朱余明,丁嘉安,高文.结核性气管支气管狭窄的外科治疗[J].中华结核和呼吸杂志,1998,21,(7):402-403.
[2]谢惠安,阳国太,林善梓,等.现代结核病学,北京:人民卫生出版社,2000,315-480。
[3]李先清,尹本义,瞿素洁.老年气管、支气管结核的纤支镜检查(附17例分析)[J].中国防痨杂志,1995,17(4):155-156.
[4]何礼贤,贾友明,李锡莹.从纤维支气管镜检查确诊的65例肺结核看肺结核与肺癌的鉴别诊断[J].中华结核和呼吸杂志,1991,14:2.
[5]王巍,王安生,庄玉辉.支气管结核诊断治疗近况[J]中华结核和呼吸杂志,2000,23(5):306-307.
[6]Kim Ho Cheol,Kim Hyeon Sik,Lee Seung Jun,et al.Endobronchial tuberculosis presenting as right middle lobe syndrome:clinical characteristics and bronchoscopic findings in 22 cases[J].Yonsei Med J,2008,49(4):615-9.
[7]陈小燕,丛丹丹,卫小红.等.容易误诊的支气管结核(附77例纤维支气管镜检查分析)[J].中国内镜杂志,1999,5(6):67-68.
[8]赵华,顾玉海,多杰.纤维支气管镜检查106例肺不张临床分析[J]中国内镜杂志,2008,14(11):1231-1232.
[9]MOON W K,IM J G,YEON KM,et al.Tuberculosis of the central airway CT findings of active and fibrotic disease[J].A JR,1997,169(3):649-653.
[10]Lee JH.Chung HS.Bronchoscopic,radiologic and pulmonary function evaluation of endobronchial tuberculosis[J].Respirology,2000,5:411-417.
[11]余文聘,容中生.支气管内膜结核90例临床分析[J].中华结核与呼吸杂志,1999,22:396-397
[12]王巍,李晓明.支气管肺泡灌洗液检查对痰涂阴性肺结核的诊断价值[J].中国防痨杂志,1995,17:171.
[13]Gracia JD,Curull V.Diagnostic value of bronchoqlveolar lavage in suspected pulmonary tuberculoa[J].Chest,1988,93:329.