Efficacy Evaluation Of Ulcerous And Necrotic Endobronchial Tuberculosis Treated By Bronchoscopy

Endobronchial tuberculosis (endobronchial tuberculosis, of EBTB), refers to the occurrence of TB in the trachea, bronchial mucosa and submucosa, also violations of the wall of the airway muscle and cartilage. About10%to40%of active tuberculosis associated with of EBTB. It’s generally believed that the incidence of women is2to3times that of men, youngers are more common, but olders there is an increasing trend. Main bronchus, upper lobe of both lungs, mid-lingual lobe bronchus is predilection site. The adult EBTB most common routes of infection of pulmonary lesions is mycobacterium tuberculosis directly into the bronchial mucosa. In recent years, with the popularity of the application of fiberoptic bronchoscopy and medical staff improve awareness of EBTB, EBTB patients’diagnosis rate is gradually increased. However, in the conventional regular course of chemotherapy in patients with remissive of clinical symptoms and the sputum conversion is slow, the involved bronchial occur different level stenosis and even lead to severe pulmonary atelectasis, severe cases require surgery. so except for conventional treatment, the EBTB patients need further intervention. In this experiment, which explore the efficacy evaluation of lesions of the trachea’further therapeutic intervention through the bronchoscope on the basis of systemic chemotherapy.Objective:To evaluate the effects of initial treating endobronchial tuberculosis with caseous necrosis by local injection antituberculotic gluey drugs through fiberoptic bronchoscope on the basis of systemic chemotherapy.Methods:Select diagnosed untreated cheese necrosis endobronchial tuberculosis45cases, divided into treatment and control groups, two groups of patients which enrolled into the group need to improve the blood, urine, liver and kidney function, chest radiograph, chest CT and sputum acid-fast stainingexamination, without abnormal liver and kidney function, once in a fortnightly review of blood chemistry, chest radiography and sputum acid-fast staining last2months, and then once a monthly review of the above examinations.Here are standard chemotherapy regimens in all two groups of patients (INH0.3QD, the RFP0.45QD, the EMB0.75QD and PZA0.5TID) and aerosol inhalation of anti-TB drug therapy (NS20ML of INH0.1amikacin0.2QD). Treatment group using the Olympus BF-lT30-type fiberoptic bronchoscope and ancillary brush, biopsy forceps, injection tube, preoperative preparation, anesthesia, procedure bronchoscopy clinical practice guidelines. The specific operation were fully attract of tracheal secretions in the bronchoscope under direct vision and application of the biopsy forceps gained the cheese necrotic material and then local infused of anti-tuberculosis drugs gel (for ourself-made gel-like anti-TB mixing drugs, matrix gel containing INH, RFP, SM, LFX, if SM allergy may be a separate dispensing), once in two weeks, stop the injection according to the condition improved. Specific stop the inject drug contain the endotracheal cheese necrotic material disappear and2consecutive negative sputum acid-fast staining. The treatment group of patients had3-7times bronchoscopy treatment until the end of observe.Results:The treatment group with remissive of clinical symptoms (mean16.2days), sputum conversion (mean25.3days), and chest radiographic improvement (mean15.4days) which all exceeded the control group. In the treatment group,21cases were exist varying degrees of bronchial stenosis when enrolled, the endobronchial cheese necrotic material has disappeared when the observe ended, the19cases of tracheal stenosis were relieve, two cases of lesions of the trachea to form granulomas, narrow compared with the previous aggravated.Conclusions:The treatment of endobronchial tuberculosis by local injection antituberculotic gluey drugs through fiberoptic bronchoscope could improve the curative rate and the prognosis, relieve bronchial stenosis and pulmonary atelectasis.