Shim Y S
Department of Internal Medicine, Seoul National University, College of Medicine, Seoul National University Hospital, Korea.
Respirology. 1996 Jun;1(2):95-106. doi: 10.1111/j.1440-1843.1996.tb00017.x.
Endobronchial tuberculosis (EBTB) is a highly infectious disease that remains a diagnostic challenge in the developed countries. It also presents as a troublesome therapeutic problem due to its sequelae of cicatrical stenosis. Due to the worldwide decrease of tuberculosis, diagnosis of EBTB is frequently delayed until the onset of serious bronchial stenosis with resultant atelectasis and bronchiectasis. The exact pathogenesis of EBTB is not yet completely understood and the course of EBTB differs according to the type. The prognosis of actively caseating type and edematous-hyperemic type EBTB is grave, resulting fibrostenosis in two thirds of patients. Fibrostenotic type EBTB shows no change or worsening of stenosis. The prognosis is good for granular and non-specific bronchitic type EBTB; however, the prognosis of tumorous type is poor, frequently resulting in bronchial stenosis despite adequate treatment. Antituberculous chemotherapy is effective in controlling the infection, but does not prevent residual bronchostenosis. Early treatment with steroid therapy is effective in certain groups of EBTB. Balloon dilatation and stent insertion is an effective treatment of bronchial stenosis id obstruction of the stent by granulation tissue overgrowth can be prevented. Future research should focus on the pathogenesis of bronchial inflammatory reaction and resulting fibrosis to prevent bronchial stenosis at the early stage.
支气管内膜结核（EBTB）是一种具有高度传染性的疾病，在发达国家仍然是一个诊断难题。由于其瘢痕性狭窄的后遗症，它也是一个棘手的治疗问题。由于全球结核病发病率下降，EBTB的诊断常常延迟，直到出现严重的支气管狭窄并导致肺不张和支气管扩张。EBTB的确切发病机制尚未完全明确，其病程因类型而异。活动性干酪型和水肿充血型EBTB的预后严重，三分之二的患者会出现纤维性狭窄。纤维狭窄型EBTB的狭窄无变化或加重。颗粒型和非特异性支气管炎型EBTB的预后良好；然而，肿瘤型的预后较差，尽管进行了充分治疗仍常导致支气管狭窄。抗结核化疗在控制感染方面有效，但不能预防残留的支气管狭窄。早期使用类固醇治疗对某些EBTB患者有效。球囊扩张和支架置入是治疗支气管狭窄的有效方法，但可防止肉芽组织过度生长导致支架阻塞。未来的研究应聚焦于支气管炎症反应及由此导致的纤维化的发病机制，以在早期预防支气管狭窄。
