[2023 年结核病介入诊断和治疗的年度进展]。

S. Yang, J. Guo, T. X. Li, S. J. Tang
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引用次数: 0

摘要

2023 年,国内外研究人员开展了一系列关于结核病介入诊断和治疗的研究。微创介入手术结合内镜、引导、多途径取材技术和多通道、高精度的实验室检测技术在临床上的应用越来越广泛,对问题结核病的准确诊断起到了重要作用。肺结核、气管支气管结核、纵隔淋巴结核和肺外结核的诊断方法包括传统的软支气管镜检查和特殊类型的支气管镜检查(超细支气管镜检查和支气管内超声检查)、经支气管针吸活检、支气管内超声和虚拟支气管镜导航系统引导的镊子活检、胸腔镜下胸膜冷冻活检、经皮活检等。利用基因 Xpert MTB/RIF、Ultra、环介导等温扩增、元基因组新一代测序或纳米孔测序等方法检测临床标本,大大缩短了诊断时间,提高了诊断效果。介入治疗主要针对以下疾病:伴有大量咯血的肺结核、气管支气管结核、胸膜结核和结核相关瘘管。气管支气管结核的介入治疗主要包括应用硬质支气管镜、支气管镜冷热消融治疗、内镜钳夹、狭窄气道球囊扩张和支架置入等。肺结核并发大咯血的介入治疗包括血管内栓塞、涂层支架置入等。胸膜结核的介入治疗包括应用胸腔镜、内镜钳、植入支架和其他闭塞装置,以及自体脂肪移植闭合瘘管。本文通过检索2022年10月至2023年9月发表的文献,回顾了结核病介入诊断和治疗的进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Annual progress of interventional diagnosis and treatment of tuberculosis in 2023].
A series of studies on the interventional diagnosis and treatment of tuberculosis(TB)were carried out by domestic and foreign researchers in 2023. The combination of minimally invasive interventional procedures with endoscopes, guidance, material acquisition techniques by multiple ways and multichannel and highly accurate laboratory testing techniques is becoming more and more widely practiced clinically, which has played an important role in the accurate diagnosis of problematic TB. Diagnostic procedures for pulmonary TB, tracheobronchial TB, mediastinal lymphatic TB and extrapulmonary TB included conventional flexible bronchoscopy and specific types of bronchoscopy(ultrathin bronchoscopy and endobronchial ultrasound), transbronchial needle aspiration biopsy, endobronchial ultrasound and virtual bronchoscopic navigation system-guided forceps biopsy, thoracoscopic cryobiopsy of pleura, percutaneous biopsy, and so on. The time to diagnosis has been significantly reduced and the diagnostic efficacy has been improved by the clinical specimen detection using either Gene Xpert MTB/RIF, Ultra, loop-mediated isothermal amplification, metagenomic next-generation sequencing, or nanopore sequencing, etc. Interventional therapy was focused on the following diseases: pulmonary TB with massive hemoptysis, tracheobronchial TB, pleural TB and TB-related fistulas. Interventional treatment of tracheobronchial TB mainly included the application of rigid bronchoscopy, bronchoscopic cold and thermal ablation treatment, endoscopic clamp, dilatations of narrow airway with balloon and stent placement, etc. The interventional treatment of pulmonary TB complicated by massive hemoptysis included endovascular embolization, coated stent placement, etc. Interventional treatment of pleural TB involved the application of thoracoscopy, endoscopic forceps, the implantation of stent and other occlusive devices and the closure of fistulas with autologous fat transplantation. In this article, we reviewed the progress of interventional diagnosis and treatment of TB by the search of published literatures from October 2022 to September 2023.
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