肺結核の診断における気管支鏡検査の有用性について

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The mortality from tuberculosis has been declining markedly in recent years and its ranking among the causes of death came down to the thirteenth in 1980. But still now patients with pulmonary tuber culosis are seen not so rarely in daily practice. When patients suspected of pulmonary tuberculosis showed negative findings of acid-fast bacilli on sputum smears, we have to wait for the results of sputum culture or have to start the anti-tuberculous therapy without having bacteriological confirmation. In order to make the definite diagnosis of pulmonary tuberculosis earlier, we performed trans bronchial lung biopsy (TBLB), brushing and washing through a fiberoptic bronchoscope in 42 patients. All patients were suspected of having an active tuberculosis by roentgenographic examinations or clinical symptoms. All of them showed negative results of acid-fast bacilli on three consecutive sputum smear examinations and/or gastric juice smear examinations or failed to produce sputum. 1) Sputum and gastric juice culture of acid-fast bacilli were positive in 6 out of 40 patients and in 5 out of 29 patients, respectively. 2) Pathological examinations of lung tissues obtained by TBLB suggested tuberculous granu lomas in 16 out of 26 patients. 3) Smear examinations for acid-fast bacilli from bronchial brushing were positive in 8 out of 37 patients. 4) Smear and culture examinations of washing after TBLB and brushing were positive in 15 and in 28 out of 42 patients, respectively. 5) Smear and culture examinations of sputum after fiberoptic bronchoscopy were positive in 6 and in 14 out of 29 patients, respectively. 6) An early definite diagnosis was made in 12 out of 13 patients with miliary tuberculosis and 15 out of 29 patients with pulmonary tuberculosis by pathological findings and by smear examinations. 7) The number of cases in which Mycobacterium tuberculosis was detected and drug sensitivity test was performed, was only 9 out of 42 patients before bronchoscopy, but it increased markedly to 32 after bronchoscopy. 8) There were no serious complications such as pneumothorax, massive bleeding, pneumonia, etc. 9) False-negative results were revealed in 8 out of 42 patients (19%). Above results suggests that TBLB, brushing and washing are useful procedures for the early diagnosis of pulmonary tuberculosis.
一般社団法人日本結核病学会の論文

肺結核の診断における気管支鏡検査の有用性について

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