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中国防痨杂志 ›› 2014, Vol. 36 ›› Issue (12): 1084-1088.doi: 10.3969/j.issn.1000-6621.2014.12.017

• 论著 • 上一篇    下一篇

电磁导航支气管镜诊断菌阴肺结核三例并文献复习

顾晔 郝晓晖 沈芸 楼海 汪浩 肖和平 沙巍   

  1. 200433 同济大学附属上海市肺科医院内窥镜室(顾晔、汪浩),结核病临床研究中心 上海市结核病()重点实验室(郝晓晖、沈芸、楼海、肖和平、沙巍)
  • 收稿日期:2014-10-18 出版日期:2014-12-10 发布日期:2015-02-28
  • 通信作者: 沙巍 E-mail:shfksw@126.com

Electromagnetic navigation bronchoscopy in the diagnosis of sputum-negative pulmonary tuberculosis: 3-case-report and literature review

GU Ye,HAO Xiao-hui,SHEN Yun,LOU Hai,WANG Hao,XIAO He-ping,SHA Wei   

  1. Department of Endoscopy, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
  • Received:2014-10-18 Online:2014-12-10 Published:2015-02-28
  • Contact: SHA Wei E-mail:shfksw@126.com

摘要: 目的 电磁导航支气管镜(ENB)技术是一种诊断肺外周结节的新技术,通过3例肺结核患者分析及相关文献复习,探讨ENB在菌阴肺结核诊断中的应用价值。方法 对2014年7—9月上海市肺科医院收治的3例疑似肺结核的菌阴患者进行ENB检查。并收集Medline上2006年至今、设计科学、入组患者数>10例、数据齐全的ENB临床研究文献共13篇,结合文献进行深入研讨。结果 本组3例患者均是正规抗结核治疗疗效不佳,反复多次痰抗酸杆菌涂片和培养均为阴性,且均为两上肺尖后段病灶,常规气管镜无法抵达。3例患者经ENB引导的刷检和活检均得到了病理学和细菌学确诊,并未出现气胸等不良反应。既往的研究表明,ENB对于肺部周围病灶具有较高的诊断成功率(59.0%~98.0%)和较高的诊断正确率(59.0%~94.0%),尤其是恶性疾病的诊断正确率可达60.0%~89.5%;但是对于结核性病变的诊断价值目前缺乏前瞻性的临床研究结果。结论 电磁导航支气管镜在不典型肺结核的诊断中将可能具有较好的临床应用前景。

关键词: 结核, 肺/诊断, 支气管镜检查

Abstract: Objective Electromagnetic navigation bronchoscopy (ENB) has been developed as a novel diagnostic tool of peripheral pulmonary nodules. To evaluate the potential value of ENB on diagnosis of sputum-negative pulmonary tuberculosis (PTB), we presented 3 PTB cases who were diagnosed by ENB and then reviewed the relative literatures. Methods During July to September in 2014, 3 adults suspected for PTB underwent ENB at Shanghai Pulmonary Hospital. The sputum smear and culture were repeatedly negative before ENB. And then the previous literatures were reviewed by searching Medline. From 2006 till now, 13 papers from clinical trials that were scientifically designed, containing >10 cases and completed data presented. Results All of 3 patients had been treated with standardized regimen for at least 4 months and had poor effects. CT showed that the lesions were located in the apicoposterior segment of the upper lobes, beyond the reach of conventional bronchoscopes. After being successfully navigated, the lesion locations were confirmed by peripheral ultrasound and specimens were sampled under X-ray assistant. The diagnosis yielded in all the cases with bacterial or pathologic technique. No procedure-rela-ted complications were observed. The results from previous research showed that the diagnose yield and accurate rate for peripheral pulmonary lesions by ENB were as high as 59.0%-98.0% and 59.0%-94.0%, respectively. For malignant lesions, the diagnostic accuracy reached 60.0%-89.5%.  However, little data is available about the clinical utilization of this technique in the diagnosis of pulmonary tuberculosis. Conclusion The ENB may have good applications in diagnosis of atypical pulmonary tuberculosis.

Key words: Tuberculosis, pulmonary/diagnosis, Bronchoscopy