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经纤支镜检查和追踪观察治愈而确诊的肺、支气管结核32例。男13例,女19例,年龄24～65岁,因痰抗酸菌检查阴性,临床最初诊断均不明确。8例有上肺浸润阴影,1例肺门结节,11例肺不张,1例诊为慢支,11例诊为阻塞性肺炎。经纤支镜检查,确诊为结核22例(活检见结核结节伴刷片抗酸菌阳性5例,单独活检见结核结节7例,刷片抗酸菌阳性8例,术后痰菌阳性2例)。另10例镜检未见直接证据,但经治疗随访3个月至2年,最后确诊为结核。镜下形态可分四种类型:①“浸润型”16例,管壁粗糙,有多个小结节或溃疡,粘膜充血水肿,间或有疤痕形成,多有灰黄色分泌物,触之易出血。活检见典型之结核结节4例,刷片抗酸菌阳性9例。5例二项检查均阴性,但经随访确诊。②“肿块型”9例,镜下可见明显肿块多为孤立性,菜花样或肉芽肿样,粘膜充血水肿,管腔被部分或完全阻塞。活检见结核结节8例,炎症肉芽肿1例,刷片抗酸菌阳性4例。
Fiberoptic bronchoscopy and follow-up observation of cured lung and bronchial tuberculosis in 32 cases. 13 males and 19 females, aged from 24 to 65 years old, due to sputum acid-negative bacteria negative, the initial clinical diagnosis are not clear. Eight cases had upper lung infiltration shadow, one case of hilar nodules, 11 cases of atelectasis, one case diagnosed as chronic bronchitis, and 11 cases diagnosed as obstructive pneumonia. Fiberoptic bronchoscopy, diagnosed as tuberculosis in 22 cases (biopsy see tuberculosis nodules with brush acid-fast bacilli in 5 cases, biopsy alone tuberculosis in 7 cases, brush acid-fast bacilli positive in 8 cases, postoperative sputum positive 2 cases). The other 10 cases no direct evidence of microscopic examination, but the treatment was followed up for 3 months to 2 years, the final diagnosis of tuberculosis. Microscopic morphology can be divided into four types: ① “infiltration type” in 16 cases, rough wall, there are multiple small nodules or ulcers, mucosal congestion and edema, between the scar formation, and more gray-yellow secretions, easy to touch the bleeding . Biopsy seen in a typical tuberculosis in 4 cases, brush acid-fast bacilli in 9 cases. 5 cases of two tests were negative, but confirmed by follow-up. ② “Mass type” in 9 cases, microscopic examination showed more obvious solitary mass, cauliflower or granuloma-like mucosal congestion and edema, the lumen was partially or completely blocked. Biopsy showed tuberculous nodules in 8 cases, 1 case of inflammatory granuloma, brush acid-fast bacillus 4 cases.