Watanabe Y, Murakami S, Oda M, Hayashi Y, Ohta Y, Shimizu J, Kobayashi K, Sato H, Kobayashi H, Nonomura A
Department of Surgery, Kanazawa University School of Medicine, Japan.
World J Surg. 1997 Jun;21(5):480-7. doi: 10.1007/pl00012273.
Between 1974 and 1995 we encountered 19 cases of bronchial stricture or obliteration caused by endobronchial tuberculous lesions. In 11 the involvements were located at the right bronchus (including involvements of segmental and middle lobe bronchi) and in 8 at the left bronchus. On bronchoscopic biopsy of the stenosed bronchus, 7 patients showed histopathologic findings of tuberculous bronchitis, but 12 patients showed nonspecific inflammatory granular tissue. Five patients were kept under conservative observation because of mild subjective symptoms or refusal to undergo operation. Two patients underwent stent procedures but had poor outcomes. Twelve patients underwent operation. As the bronchial lesions in four of them were confined to the lobar or segmental bronchus, lobectomy was performed. One patient with a history of infantile tuberculosis had developed complete obliteration of the left main bronchus and cystic bronchiectasis in the entire lung parenchyma; pneumonectomy was essential. Seven patients who had strictures involving the main bronchus underwent bronchoplastic surgery with right (n = 4) or left (n = 3) upper sleeve lobectomy. None of the patients treated surgically showed any postoperative complication or recurrence of the tuberculosis. These surgical results for endobronchial tuberculosis indicate the need for early detection and operation. Bronchoscopy and computed tomography are the methods of choice for accurate diagnosis of bronchial involvement and assessment of the surgical indications. It is emphasized that bronchoplastic surgery is the best treatment for bronchial stricture involving bilateral main bronchi.
1974年至1995年间，我们遇到19例由支气管内膜结核病变引起的支气管狭窄或闭塞病例。其中11例病变位于右支气管（包括段支气管和中叶支气管受累），8例位于左支气管。对狭窄支气管进行支气管镜活检时，7例患者显示出结核性支气管炎的组织病理学表现，但12例患者显示为非特异性炎性颗粒组织。5例患者因主观症状较轻或拒绝手术而接受保守观察。2例患者接受了支架置入术，但效果不佳。12例患者接受了手术。其中4例患者的支气管病变局限于叶支气管或段支气管，因此进行了肺叶切除术。1例有婴儿期结核病史的患者，左主支气管完全闭塞，全肺实质出现囊性支气管扩张，必须进行全肺切除术。7例主支气管受累的患者接受了右（n = 4）或左（n = 3）上叶袖状肺叶切除术的支气管成形手术。接受手术治疗的患者均未出现任何术后并发症或结核复发。这些支气管内膜结核的手术结果表明需要早期发现和手术。支气管镜检查和计算机断层扫描是准确诊断支气管受累情况和评估手术指征的首选方法。强调支气管成形手术是治疗累及双侧主支气管的支气管狭窄的最佳方法。
