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目的探讨纤维支气管镜对老年慢性阻塞性肺疾病(COPD)合并单纯性支气管结核的诊断价值。方法回顾性分析11例经纤维支气管镜确诊的老年COPD合并单纯支气管结核患者的临床资料、镜下表现及病理类型。结果11例老年患者男女比例1:0.375,临床症状及体征无特异性。镜下检查均有异常改变,其中浸润型3例,溃疡型2例,增殖型1例,淋巴支气管瘘(穿孔后期)2例,非特异性支气管炎型4例。镜下活检6例,阳性4例;刷检11例,阳性6例,支气管灌洗9例,阳性5例。结论老年COPD合并支气管结核患者临床无特异性,仅靠痰细胞学及胸部X线检查难免造成误诊。纤维支气管检查对老年COPD合并支气管结核诊断有重要作用,活检联合刷检、灌洗液找抗酸杆菌,可以相互补充,提高阳性率。
Objective To investigate the diagnostic value of fiberoptic bronchoscopy in senile chronic obstructive pulmonary disease (COPD) complicated with simple bronchial tuberculosis. Methods The clinical data, microscopic findings and pathological types of 11 elderly COPD patients with bronchial tuberculosis diagnosed by bronchofiberscopy were retrospectively analyzed. Results The ratio of male to female in 11 elderly patients was 1: 0.375. Clinical symptoms and signs were not specific. Microscopic examination showed abnormal changes, including infiltration in 3 cases, ulceration in 2 cases, proliferation in 1 case, lymphatic bronchial fistula (late perforation) in 2 cases, nonspecific bronchitis in 4 cases. Microscope biopsy in 6 cases, 4 were positive; brushing in 11 cases, 6 were positive, bronchial lavage in 9 cases, 5 were positive. Conclusion Elderly patients with COPD complicated by bronchial tuberculosis are non-specific and can only be misdiagnosed by sputum cytology and chest X-ray examination. Fiberoptic bronchial tuberculosis in elderly COPD diagnosis of bronchial tuberculosis have an important role in biopsy joint brushing, irrigation fluid looking for acid-fast bacilli, can complement each other to improve the positive rate.