Ali KÖMÜRCÜOĞLU, Gülru POLAT, Gülay UTKANER, Sabri KALENCİ, Gültekin TİBET

BALGAM ÇIKARAMAYAN VE YAYMA NEGATİF AKCİĞER TÜBERKÜLOZU OLGULARINDA FİBEROPTİK BRONKOSKOPİNİN TANISAL DEĞERİ

Balgam çıkaramayan ve yayma negatif akciğer tüberkülozu olgularında fiberoptik bronkoskopi (FOB) ile yapılan uygulamaların tanısal değeri araştırıldı. 1995-1999 yılları arasında kliniklerimizde aktif akciğer tüberkülozu tanısı konulmuş ve tanı için FOB yapılmış 111 olgu çalışmaya alındı. Olguların 32'si balgam çıkaramayan, 79'u yayma negatifti. Bronkoskopi öncesi alınan mide suyu kültürlerinde %7 (2/32), balgam kültürlerinde %33 (26/79) olmak üzere toplam %25 (28/111) olguda kültür pozitifliği saptandı. FOB ile 40 (%36) olguya erken tanı konuldu. FOB toplam 64 (%56) olguda tanısaldı. FOB ile yapılan uygulamaların yayma ve kültür pozitiflik oranları sırasıyla, bronş lavajı %16-31, bronkoalveoler lavaj %10-25, bronşiyal fırçalama %20-0, transbronşiyal biyopsi %21-0 ve post bronkoskopik balgam %24-41 olarak saptandı. Uygulanan yöntemlerin tanısal verimlilikleri arasında istatistiksel olarak anlamlı fark saptanmadı. FOB ile yapılan uygulamaların balgam çıkaramayan ve yayma negatif akciğer tüberkülozu olgularında tanısal yarar sağladığı sonucuna varıldı.

Anahtar Kelimeler:

Akciğer tüberkülozu, tanı, bronkoskopi

DIAGNOSTIC VALUE OF FIBEROPTIC BRONCHOSCOPY IN PULMONARY TUBERCULOSIS CASES WHO COULD NOT EXPECTORATE AND SMEAR NEGATIVE

In this study, the diagnostic value of fiberoptic bronchoscopy (FOB) and related applications in pulmonary tuberculosis cases who could not expectorate and smear negative was investigated. One hundred and eleven cases who were diagnosed as active pulmonary tuberculosis and FOB applied for the diagnosis between 1995-99 years involved in the study. Thirtytwo of cases could not expectorate and 79 were smear negative. 7%(2/32) of gastric juice cultures, 33%(26/79) of sputum cultures totally 25%(28/111) of materials which were taken before bronchoscopy were positive. FOB provided early diagnosis in 40(36%) cases. FOB was diagnostic in 64(56%) cases. Smear and culture positivity in FOB related applications was determined as; 16-31% in bronchial lavage, 10-25% in bronchoalveolar lavage, 20-0% in bronchial brushing, 21-0% in transbronchial biopsy and 24-41% in postbronchoscopic sputum respectively. There is no statistically significant difference between the diagnostic values of the methods. FOB and related applications were usefull in pulmonary tuberculosis cases who could not expectorate and smear negative.

Keywords:

Pulmonary tuberculosis, diagnosis, bronchoscopy,

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