The Value Of Diagnosis And Treatment Of Activity Bronchial Tuberculosis Treated By Fiberoptic Bronchoscopy

Tracheobronchial tuberculosis(TBTB)refers to the occurrence of mycobacterium tuberculosis confirmed by etiology or histopathology in the trachea,bronchial mucosa and sub-mucosa,with the development,may also involve in the wall of the airway muscle and cartilage.If we do not intervene in time,it will gradually appear wall thickening and luminal stenosis,resulting obstructive pneumonia and atelectasis in the narrow distal airway,and seriously affecting the patient’s respiratory function.Now about 4.1% ～ 38.8% of TB patients involvement with bronchial [2],it is the most important complications,also the most common complications of pulmonary tuberculosis.In recent years,as the incidence of tuberculosis rising year by year,meanwhile,the lack of specificity of TBTB clinical manifestation,and often occurrence of misdiagnosis,missed diagnosis,and delayed treatment,lead to the course of disease extension,wall thickening and luminal stenosis,and seriously affecting the patient’s respiratory function even threatening life.TBTB is often misdiagnosed by bronchial asthma,acute bronchitis,and tumor,the occurrence increased year by year.So we need further study more about TBTB clinical manifestations,the characteristics under fiberoptic bronchoscopy,it has a positive effect on early diagnosis and therapy TBTB.The active TBTB were divided into two groups,comparing the curative effect of conventional treatment with the interventional treatment,in order to verify the security and effectiveness of interventional treatment via bronchoscope.Select diagnosed untreated 55 cases as object in the study,including Inflammatory infiltration,cheese necrosis,granulation proliferative,discussing the treatment efficacy through BF-260 type of fiber bronchoscope and local injection tuberculosis drug in the lesions trachea(isoniazide,rifampicin,pyrazinamide mixture with a gel matrix)Objective: To study the TBTB clinical manifestations,and divide into two groups,comparing the curative effect of conventional treatment with the interventional treatment,it has a positive effect on early diagnosis and therapy TBTB and reducing the complications,in order to verify the security and effectiveness of interventional treatment via bronchoscope.Methods: Retrospective analysis untreated active TBTB 55 cases confirmed by fiber bronchoscope examination,which were divided into combined treatment group 29 cases and conventional treatment group 26 cases.Here are conventional treatment group in all two groups 2HRZE/4HR(INH 0.3qd,RFP 0.45 qd,EMB 0.75 qd,PZA 0.5 tid)and aerosol inhalation(NS 20 ML of INH 0.1qd).Combined treatment group: The specific operation were gained the cheese necrotic material by biopsy forceps and fully attract of tracheal secretions for cheese necrosis using Olympus BF-260-type fiberoptic bronchoscope and then local infused of anti-tuberculosis drugs(isoniazide,rifampicin,pyrazinamide mixture with a gel matrix).The other two types are injected directly into the tuberculosis drug.Results: There are 17 female and 38 male in the 55 cases of TBTB patients,the ratio is 1:2.2,the 21 to 30 years old patients,more than half,are the main part;clinical symptoms are mainly in cough and expectoration,respectively accounted for 84.5%(47/55),80%(44/55);misdiagnosed as pneumonia were the main part in the 55 patients with TBTB,accounted for the proportion of 54.55%(30/55),the pulmonary atelectasis 12.73%(7/55),lung cancer and bronchitis respectively accounted for 9.09%(5/55),they were exactly diagnosed as TBTB by bronchoscope;The upper bronchus were main location in active TBTB,accounted for 43.63%(24/55);Active TBTB with ulceration necrosis were the most common,accounted for 61.82%(34/55),granulation proliferative accounted for 30.91%(17/55),inflammatory infiltration accounted for 7.27%(4/55);The combined treatment group with clinical symptoms such as cough and expectoration,sputum conversion,chest radiographic,which all were superior to the conventional treatment group(93.10% vs73.08 %,P = 0.045 < 0.05);In the combined treatment group,cheese necrotic material has disappeared and tracheal unobstructed in 19 cheese necrosis cases;6 of the 8 cases granulation proliferative tracheal stenosis were relieve,2 cases with cicatricial stenosis and even the wall soften;in conventional treatment group,only 7 of 15 cases cheese necrosis material has disappeared and tracheal unobstructed;3 of the 9 cases granulation proliferative tracheal stenosis were relieve,4 cases narrow aggravated compared with the previous,2 cases no change,the inflammatory infiltration of two groups lesions are improved.Conclusions: 1、Bronchial tuberculosis mainly occur in women,the 21 to 30 years old patients are main part;2、clinical symptoms are mainly in cough and expectoration,the lack specificity in clinical manifestation of TBTB,according to the high occurrence rate of misdiagnosis and missed diagnosis,we should early take bronchoscope for suspicious TBTB patients;3 、 Bronchoscope is an important inspection method for diagnosis of TBTB,The upper bronchus were main location in active TBTB.Active TBTB with ulceration necrosis were the most common;4、Local injection anti-tuberculotic drugs on the base of systemic chemotherapy drugs and atomizing inhalation for untreated active TBTB could improve the curative rate and the high safety.