I. Overview.
Bronchial tuberculosis refers to tuberculosis occurring in the trachea, bronchial mucosa or submucosa, and cartilage and smooth muscle layer.Bronchial tuberculosis is clinically divided into four types: congested edema type, ulcerated type, granulomatous nodules, and scar stenosis type.In recent years, with the widespread use of bronchoscopy, people have further improved their understanding of bronchial tuberculosis.It was found that in recent years, due to the increase of drug-resistant tuberculosis and According to the literature, early diagnosis and effective treatment of bronchial tuberculosis are of great importance to control the source of infection, reduce the incidence, improve the cure rate and reduce the disability rate. The cure rate has been greatly improved.
II. Diagnosis.
1, the key to successful treatment of bronchial tuberculosis lies in early and correct diagnosis, timely and effective systemic anti-tuberculosis treatment and endobronchial local treatment.
Bronchoscopy is the most important means of bronchial tuberculosis diagnosis. Bronchoscopy can clarify the presence, type, location, extent and severity of bronchial tuberculosis.
For early and timely diagnosis of bronchial tuberculosis, if there is no absolute contraindication to bronchoscopy, the presence of tracheal and bronchial tuberculosis should be highly suspected in one of the following cases, and bronchoscopy should be performed as early as possible.
Examination.
1. Patients with pulmonary tuberculosis whose symptoms do not improve after one month of anti-tuberculosis treatment.
2. Patients with pulmonary tuberculosis who have increased and enlarged lesions on the affected side during antituberculosis treatment.
3. Patients with pulmonary tuberculosis who have obstructive pneumonia, pulmonary atelectasis, poorly inflated lungs or limited emphysema on X-ray and other examinations.
4.Patients with pulmonary tuberculosis who have clinical symptoms such as shortness of breath and dyspnea that do not correspond to the severity of the lung lesions.
5.Tuberculosis patients with chest CT scan, HRCT, tracheal and bronchial reconstruction and other examinations suggesting rough or unsmooth tracheal or bronchial lining, or with lobe or segmental bronchial stenosis or occlusion.
6. Chronic severe cough of unknown origin, hemoptysis, especially those with positive sputum tuberculosis examination and negative lung imaging examination.
III. Transbronchoscopic interventional treatment strategy.
1. Principles.
1. Preoperative evaluation of the nature, location, degree, length and relationship with the surrounding blood vessels, especially the patency of the distal trachea and lung function status;
2.According to the evaluation results and the clinical typology of tracheal tuberculosis, a reasonable interventional treatment method should be measured;
3. Effective systemic anti-tuberculosis treatment is the basis of bronchial tuberculosis treatment and the prerequisite for interventional treatment.
2. Traditional local treatment.
Nebulized inhaled isoniazid, isoniazid plus hormone therapy; bronchoscopic local injection of anti-tuberculosis drug therapy.
3.New interventional treatment strategies via bronchoscopy.
1, congested edema type, granulomatous nodular type distal non-obstruction: using freezing plus local injection.
2, ulcerative erosion necrosis so that part of the trachea obstruction: argon knife, electric knife freeze cut → freezing plus local drug injection.
3, granulation tissue proliferation leading to luminal stenosis and obstruction, pulmonary atelectasis: argon knife, electric knife freezing and cutting → freezing → balloon expansion → local injection.
4.scar stenosis and severe luminal stenosis: balloon dilation → freezing → balloon dilation.
5, scar stenosis combined with softening of the duct wall: balloon dilation followed by stent placement and removal of the stent after 2-3 months of airway remodeling.
Summarization.
Bronchoscopic multiple interventional methods combined with bronchial tuberculosis have a broad developmental prospect and are the best means of internal medicine for the treatment of bronchial tuberculosis. Since most doctors and patients fail to recognize the danger of bronchial tuberculosis at present, bronchoscopy and treatment of tuberculosis patients are not popular in many hospitals, especially primary hospitals, and only by improving the professional doctors’ knowledge of tuberculosis and bronchial tuberculosis Only by increasing the depth of knowledge of tuberculosis and bronchial tuberculosis among medical professionals and by increasing the public awareness rate of tuberculosis to 57%, will it be possible to curb the current situation of tuberculosis and eventually achieve the goal of eliminating tuberculosis.