Analysis Of Effect Of Fiber Bronchoscopic Treatment For Endobronchial Tuberculosis

Endobronchial tuberculosis(EBTB) is a type of tuberculosis of lung, the pathogenic site located in tracheal,bronchial mucosa or submucosa, and may involve smooth muscle,cartilage and outer membrane of tracheal. If not timely treatment, it can cause wall softening, scar healing,and cause tracheal or bronchia lumen stenosis.With the evolve of the disease,it can lead to recurrent pulmonary infection, bronchiectasis, atelectasis and other serious complications, respiratory failure,asphyxia even death in some severe condition.On the basis of routine therapy,positive intervention is applied on patients,it can maximally preserve the patient’s lung function and improve the patients quality of life. Objective: To observe the clinical effect,bacteriology, airway lesion,adverse reactions and prognosis of treating endobronchial tuberculosis via fiberoptic bronchoscope combined with systemic chemotherapy. Methods:Used the methods of retrospective analysis,collected untreated endobronchial tuberculosis 134 cases between April 2007 and January 2013 in TB department of Tanggu Infection Hospital.All patients were diagnosed by bacteriology and(or) pathology and untreated,selected 97 cases, divided into treatment and control groups.All patients have complete data,good compliance and actively cooperate with treatment,don’t have serious heart,liver and kidney disease.All patients need the blood,urine,liver and kidney function test and radiograph,CT of chest,acid-fast staining examination of sputum.All patients receive the chemotherapy of tuberculosis,the plan is 3HRZE/9HR,and the treatment of protecting liver and kidney,12 months.Treatment group used the fiberoptic bronchoscope to attract tracheal secretions and cheese necrotic material and to inject drug in the location(INH 0.2g,amikacin 0.2,levofloxacin 0.1g,dexamethasone 5mg)once a week,8 ~ 12 times according to the condition.Affter 6 months, all patients reviewe fiberoptic bronchoscope,once in a fortnightly review of blood,urine,liver and kidney function,once a monthly review of sputum acid-fast staining examination. Results: 1.34.0% of all patients under the age of 30,71.1% of all patients were female.All patients had cough and expectoration,23.7% of all patients had limitations of dry song. 57.7% of all patients had airway disease risk in the two upper lobe bronchus,in which the upper lobe bronchus of right relatively more, accounting for 36.1%.Two groups of patients in age,sex ratio,clinical manifestations and the position of airway disease risk have no statistical significance(P>0.05). 2.After 6 months,the total effective rates of treatment group was 81.6%higher than treatment group 60.4%,two groups have statistical difference(P<0.05).The sputum negative rates of treatment group was 83.3%higher than control group 57.5%,two groups have statistical difference(P<0.05) 3.After 6 months,all patients reviewe fiberoptic bronchoscope,the curative effect rates of treatment group was 77.5% higher than control group 58.3%,two groups have statistical difference(P<0.05).In different types of bronchial tuberculosis,the total effective rates of treatment group was higher than treatment group,the two groups have statistical difference(P<0.05).After 12 months, all the patient of treatment group finish the treatment,higher than the control group 62.5%,there was statistical difference between the two groups(P<0.05). 4.On anti-tuberculosis treatment of adverse reactions occur,treatment group was 18.4% with control group was 14.6%,two groups have no statistical difference(P>0.05). Conclusions: 1.Young and women were vulnerable population.Cough and expectoration was the main symptom, limitations of dry song was the main positive signs.there was not obvious specificity of clinical manifestations.Two upper lobe bronchus were predilection site. 2.Systemic chemotherapy combined with fiberoptic bronchoscope leaded to a higher sputum negative rates,fastere rcover of microscopic lesions,better clinical effect and short treatment period of treatment. 3.The inflammatory infiltration type of bronchial tuberculosis curative effect is best, for part of ulcers effectively, type of granulation proliferative and necrosis scar stricture is invalid. 4.Bronchoscopy intervention had less adverse reaction and did not increase the rate of adverse reactions of the chemotherapy treatment.