Shim Y S
Department of Internal Medicine, Seoul National University College of Medicine, Korea.
Kekkaku. 1992 Apr;67(4):353-7.
Endobronchial tuberculosis frequently leaves bronchial stenosis as the complication despite of modern efficacious chemotherapy, and it may be misdiagnosed as bronchial asthma or bronchogenic carcinoma. When bronchial stenosis involves major airway, its treatment needs such special measures as steroid therapy, surgical intervention and/or laser therapy, but the therapeutic result is often disappointing. We have introduced a new classification of endobronchial tuberculosis, analyzing bronchoscopic findings in 166 cases of endobronchial tuberculoses. Namely, endobronchial tuberculosis was classified into seven subtypes as stenotic type with fibrosis, stenotic type without fibrosis, actively caseating type, tumorous type, ulcerative type, granular type, and nonspecific bronchitic type. Actively caseating type (48 cases: 28.9%), stenotic type without fibrosis (44 cases: 26.5%), nonspecific bronchitic type (31 cases: 18.7%) and stenotic type with fibrosis (30 cases: 18.1%) were predominant in the order of frequency, but tumorous type (9 cases: 5.4%), ulcerative type (2 cases: 1.2%) and granular type (2 cases: 1.2%) were relatively uncommon. Stenotic type with or without fibrosis, actively caseating type and tumorous type of endobronchial tuberculosis were closely related to bronchial stenosis. In these cases, it is necessary to apply specific measures for preventing or minimizing bronchial stenosis. To consider the therapeutic effect of steroid on the alleviation of bronchial stenosis in endobronchial tuberculosis, it may be very effective when the interval between symptom-onset and treatment with steroid is less than 6 months. To exploit a new treatment modality for bronchial stenosis, balloon dilatation was also carried out in 12 patients with endobronchial tuberculosis. Under local anesthesia, 4F-Fogarty balloon was inserted via bronchofiberscope in ten cases and 10F-Gruentzig balloon was introduced under fluoroscopic guide in two others.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管现代有效化疗手段不断发展，但支气管内膜结核仍常并发支气管狭窄，且可能被误诊为支气管哮喘或支气管源性癌。当支气管狭窄累及主气道时，其治疗需要采取诸如类固醇疗法、手术干预和/或激光疗法等特殊措施，但治疗效果往往不尽人意。我们对166例支气管内膜结核患者的支气管镜检查结果进行分析，提出了一种支气管内膜结核的新分类方法。具体而言，支气管内膜结核分为七种亚型，即纤维化狭窄型、无纤维化狭窄型、活动干酪型、肿瘤型、溃疡型、颗粒型和非特异性支气管炎型。按出现频率依次为活动干酪型（48例，占28.9%）、无纤维化狭窄型（44例，占26.5%）、非特异性支气管炎型（31例，占18.7%）和纤维化狭窄型（30例，占18.1%）为主，而肿瘤型（9例，占5.4%）、溃疡型（2例，占1.2%）和颗粒型（2例，占1.2%）相对少见。有或无纤维化的狭窄型、活动干酪型和肿瘤型支气管内膜结核与支气管狭窄密切相关。对于这些病例，有必要采取特定措施预防或尽量减少支气管狭窄。考虑到类固醇对缓解支气管内膜结核所致支气管狭窄的治疗效果，症状出现与类固醇治疗间隔小于6个月时可能非常有效。为探索支气管狭窄的新治疗方式，我们还对12例支气管内膜结核患者实施了球囊扩张术。其中10例在局部麻醉下经纤维支气管镜插入4F-Fogarty球囊，另外2例在透视引导下置入10F-Gruentzig球囊。（摘要截选至250词）
