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支气管内超声引导下的经支气管针吸术在胸内淋巴结结核临床诊断及鉴别诊断中的应用分析
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Abstract:
胸内淋巴结结核是少见的肺外结核形式，其发病率较低，常需要与恶性肿瘤、良性疾病或其他感染性疾病相鉴别。但由于痰中结核分枝杆菌的检出率较低，临床表现不明显，普通纤维支气管镜下表现无特殊性，影像学表现缺乏特异性，这使得它难以通过普通支气管镜、影像学与恶性肿瘤、结节病、淋巴瘤等疾病相互鉴别。超声支气管镜作为一个可以详细展现淋巴结内部结构的诊断工具，为分析淋巴结结核病变的区域、了解其内部结构特征，同时可以经细针穿刺获取病理活检提供了更为深入的视角。本文通过系统地回顾和分析国内外文献，总结了胸内淋巴结结核在超声内镜检查下及胸部CT的影像学特点，以及与转移瘤、结节病、淋巴瘤等其他纵隔疾病的鉴别要点；讨论了超声内镜对于提升胸内结核诊断准确率的重要性，旨在为临床医生提供实用的诊断思路和指南，进一步提高纵隔肺门淋巴结结核的确诊率。
Intrathoracic lymph node tuberculosis is a rare form of extrapulmonary tuberculosis characterized by a low incidence. It often necessitates differentiation from malignant tumors, benign conditions, and other infectious diseases. However, the challenge lies in the low detection rate of Mycobacterium tuberculosis in sputum samples, coupled with non-specific clinical manifestations and imaging findings that complicate diagnosis. The typical presentations observed during standard bronchoscopy are not distinctive, making it difficult to differentiate this condition from malignant tumors, sarcoidosis, and lymphoma through conventional bronchoscopy and imaging techniques. Ultrasonic bronchoscopy serves as an advanced diagnostic tool capable of providing detailed visualization of the internal structure of lymph nodes. This technique offers deeper insights into the characteristics of tuberculous lesions within lymph nodes and facilitates pathological biopsy via fine needle aspiration. This paper systematically reviews and analyzes both domestic and international literature to summarize the imaging features associated with intrathoracic lymph node tuberculosis as observed through endoscopic ultrasonography and chest CT scans. Additionally, it highlights key differentiating factors between metastasis, sarcoidosis, lymphoma, and other mediastinal disorders. The discussion emphasizes the significance of endoscopic ultrasonography in enhancing diagnostic accuracy for intrathoracic lymph node tuberculosis. The objective is to provide practical diagnostic strategies and guidelines for clinicians while aiming to improve the overall diagnosis rate for mediastinal hilar lymph node tuberculosis.
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