Feinsilver S H, Fein A M, Niederman M S, Schultz D E, Faegenburg D H
Department of Pulmonary and Critical Care Medicine, Winthrop University Hospital, Mineola, NY.
Chest. 1990 Dec;98(6):1322-6. doi: 10.1378/chest.98.6.1322.
Although fiberoptic bronchoscopy (FOB) has been traditionally used to evaluate nonresolving pneumonia, its efficacy is unknown. We, therefore, reviewed FOB in 35 consecutive patients who had (1) a roentgenographic infiltrate, (2) cough, (3) either temperature greater than 38.1 degrees C, leukocytosis, sputum production, (4) symptoms present for at least ten days, and antibiotic therapy for at least one week. Known lung cancer and AIDS were excluded. Fiberoptic bronchoscopy was diagnostic in 86 percent (12/14) in whom a specific cause was found. No patient had endobronchial cancer. Two patients with nondiagnostic FOB and persistent systemic symptoms had open lung biopsy specimens showing Wegener's granulomatosis and bronchiolitis obliterans with organizing pneumonia (BOOP). Twenty-one patients with nondiagnostic FOB had no final diagnoses other than community-acquired pneumonia. We conclude that FOB is extremely useful in finding a specific diagnosis for a nonresolving pneumonia when a specific diagnosis can be made. Fiberoptic bronchoscopy was most likely to yield a specific diagnosis in nonsmoking patients with multilobar infiltrates of long duration and could have been avoided in older, smoking, or otherwise compromised patients with lobar or segmental infiltrates with no decrease in diagnostic yield in our series.
尽管传统上一直使用纤维支气管镜检查（FOB）来评估迁延不愈的肺炎，但其疗效尚不清楚。因此，我们回顾性分析了35例连续患者的FOB检查情况，这些患者具备以下条件：（1）胸部X线片有浸润影；（2）咳嗽；（3）体温高于38.1℃、白细胞增多、有痰；（4）症状持续至少10天，且接受抗生素治疗至少1周。排除已知肺癌和艾滋病患者。在发现特定病因的患者中，纤维支气管镜检查的诊断率为86%（14例中的12例）。没有患者患有支气管内癌。2例纤维支气管镜检查未明确诊断且全身症状持续的患者，经开胸肺活检标本显示为韦格纳肉芽肿和机化性肺炎型闭塞性细支气管炎（BOOP）。21例纤维支气管镜检查未明确诊断的患者，除社区获得性肺炎外无最终诊断。我们得出结论，当能够做出特定诊断时，纤维支气管镜检查对于迁延不愈的肺炎寻找特定诊断极为有用。纤维支气管镜检查最有可能在患有长期多叶浸润的非吸烟患者中得出特定诊断，而在我们的系列研究中，对于患有叶或段浸润的老年、吸烟或其他身体状况不佳的患者，纤维支气管镜检查本可避免，且诊断率并无下降。
