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UDC 616.233-002,5
A.V. ALIYEV
DIAGNOSIS OF BRONCHIAL STENOSIS DUE TO ENDOBRONCHIAL TUBERCULOSIS
Guba Central Hospital, Ministry of Health, Azerbaijan, Guba
Abstract.
The subject of our article is bronchial stenosis as a consequence of endobronchial tuberculosis. Appearance of possible mechanisms of endobronchial tuberculosis infection include a direct hit in the bronchus from the adjacent lung parenchyma damage, erosion and protrusion of hyperplastic intrathoracic lymph node in the lumen of the bronchus and hematogenous spread [1, 2, 3, 4]. One of the complications of the endobronchial tuberculosis is bronchial stenosis.
Computed tomography (CT) and bronchofibroscopy are the main methods for determining the central airways. Some authors choose the use of conventional CT as a guide for bronchoscopy helping optimize the diagnostic approach and therapeutic procedures. Virtual bronchoscopy can define the condition of all levels of the respiratory tract beginning from the upper airway and finishing to the lungs [5, 6].
In the present review of article was gathered and analyzed by the data cover 10 years of practice of bronchologist scientists and TB specialists from around the world.
Key words: bronchial stenosis, respiratory ways, bronchoscopy, endobronchial tuberculosis.
Natural history
Bronchial stenosis narrows a bronchus [7]. It is a complication of tuberculous or lymph node disease and may adversely affect its treatment [8, 9, 10]. The result of bronchial stenosis from tuberculosis may be caused by granulamatous changes in the bronchial wall or by extrinsic pressure from enlarged peribronchial lymph nodes [11].
There are two main theories concerning the development: one of them holds the bronchial changes originate from the contact of the mucosa with the infected sputum from the lesions in the distal lung parenchyma, particularly with cavities [12]. More recent theory suggests a submucosal spread of tubercle bacilli which is passed through lymph from the lung parenchyma, and is followed by the formation of submucosal tubercles and subsequent mucosal ulceration.
Intrathoracic lymph nodes lesion is not to isolate specific process. At tuberculosis the lymph nodes of a root of a lung pathological process passes from lymph nodes and through their capsules in surrounding tissues, and then in walls of bronchial tubes and amazes all layers of bronchial walls. After that caseose, the weight from a lymph node, opening itself way, passes in a gleam of a bronchial tube and forms fistulas [13, 14]. In weight perforation caseose of a wall of a bronchial tube can be small and is not visible at bronchoscopy. During perforating it forms infiltration mucous membranes, then granulation and at last develops. There is a cicatricial tissue around of perforating. Granulations and cicatrices can lead to deformation.
The degree of fibrostenosis depends from the depth of the ulcer [15]. Once ulceration occurs, there is some degree of residual fibrosis even with treatment [16]. Patients with endobronchial tuberculosis bronchial stenosis may develop from 3 to 6 month.
Pathogenesis
The pathogenesis of endobronchial tubersulosis is not yet fully established. However, sources of endobronchial stenosis may include direct implantation of tubercle bacilli into the bronchus from an adjacent pulmonary parenchymal lesion, direct airway infiltration from an adjacent tuberculous mediastinal lymph node, erosion and protrusion of an intrathoracic tuberculous lymph node into the bronchus, hematogenous spread and extension of the peribronchial region of lymphatic drainage. Fibrosis develops with scarring of the bronchial wall [17]. Bronchial stenosis caused by endobronchial tuberculosis may present with severe respiratory symptoms, atelectasis and secondary pneumonitis.
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Patients with fibrostenotic endobronchial tuberculosis presented with narrowing of the bronchial lumen with fibrosis [18, 19]. Usually, the endobronchial tuberculous lesion did not circularly involve the bronchial mucosa and the normal mucosa was partly spared. Therefore, the stenotic bronchial lumen became a crushed water drop shape. In some cases, the bronchial lumen was completely occluded [20, 21]. It was not easy to obtain biopsy specimens because of dense fibrosis, but active tuberculosis could be diagnosed with bronchoscopic biopsy from the inflamed mucosa at the periphery of the lesion [22].
Diagnosis
Chest radiograph
Endobronchial tuberculosis is usually accomptained by lung parenchyma involvement and in most cases roentgenological findings are characterized by signs of pulmonary tuberculosis [23, 24]. Radiologic manifestations of tuberculous bronchial stenosis include atelectasis, persistent segmental or lobar collapse, lobar hyperinflation and obstructive pneumonia [25]. The position of an obstructing lesion can be predicted by recognizing which lobes are collapsed or overinflated. Volume loss or totally shadowing on the chest, radiography may indicate development of bronchial stenosis, and fibreoptic bronchoscopy (FOB) should be considered in such cases [26]. From 10 to 20 percent patients with endobronchial tuberculosis may have a normal chest radiograph. Clear chest radiographs not exclude the diagnosis of endobronchial tuberculosis.
Fibreoptic bronchoscopy
FOB confirmed its usefulness in the diagnosis of tuberculosis and in monitoring the course and the outcome of the bronchial tuberculosis involvement [27, 28]. Bronchoscopic findings are infiltration of mucosa. The mucosa is nodular, red, and vascular and sometimes ulcerated [29, 30, 31]. It may stimulate a bronchogenic carcinoma [32].
Bronchoscopic findings strongly suggest that bronchial stenosis or obliteration with anthrocotic (black) pigmentation in the mucosa was caused by a fibrotic response to active old tuberculous infection [33, 34]. Anthrocotic pigment can see in the bronchial mucosa, particularly in the region of strictures. Endobronchial changes are detected by bronchoscopy, not always predicted prior to the examination, and must be investigated trough bronchial biopsy [35]. Biopsy specimens must obtain from all of the obstructed sites, observed through the bronchoscope [36]. Tuberculous bacilli are determined by bronchial washing examination [37]. In diagnosing of endobronchial tuberculosis, experience of the bronchoscopist is also of great importance for eliciting the bronchoscopic findings that contribute to the diagnosis.
Although FOB is an essential tool for diagnosis and follow up endobronchial tuberculosis, it has several limitations: the first, FOB can not reveal the distal portion of strictured bronchus, if the diameter is narrower than bronchoscope; the second, FOB can show only the mucosal surface of bronchus, so it cannot evaluate the outer wall of diseased bronchus or peribronchial soft tissue; the third, FOB can not reveal the peribronchial or mediastinal lymph node enlargement. Chest CT may partly compensate for this disadvantage [38, 39].
CT scan
The advantages of CT over FOB can visualize airways beyond a severe stenosis that are not accessible to FOB and that is beneficial in following the response to treatment, especially when the bronchial biopsy shows only nonspecific changes [40]. Main clinical applications include localization and measurement of bronchial stenosis [41]. Also it may be easier to measure the degree of stenosis at CT compared with the view obtained at FOB [42, 43]. Whereas the extraluminal extent of an abnormality is not visible at FOB, it can generally be demonstrated at CT. Analysis of the shape, content, density and anatomic relationships of the lesion on the successive contiguous CT images can contribute to determining the precise etiology of a bronchial stenosis. CT can demonstrate regular or irregular narrowing of the airways, thickening of the bronchial wall, sometimes with dense calcium deposits or extrinsic airway compression by enlarged lymph nodes. Bronchial narrowing or obliteration with peribronchial cuffs of soft tissue or lymph nodes were the principal findings in chest CT. When bronchial tumors are not visible at FOB, CT can be useful to guide the taking of bronchial or transbronchial biopsy by showing the relationship between the bronchial tree and peripheral carcinomateus lesions.
Virtual bronchoscopy
The CT scan data can be reformatted into three-dimensional images to create virtual bronchoscopic renderings that closely resemble the images obtained from FOB [44, 45]. Virtual bronchoscopy provides an internal rendering of the bronchial walls and lumen [46, 47]. The observer may interactively move through the airway. Virtual bronchoscopy is better than all other CT methods is revealing detail needed for the accurate grading of bronchial stenosis. Virtual endoscopy is applicable to the central airways including the subsegmental bronchi. The technique allows accurate reproduction of major endoluminal abnormalities with an excellent correlation with fiberoptic bronchoscopy results regarding the location, severity of airway narrowing [48, 49, 50]. Virtual endoscopy is also able to visualize the bronchial tree beyond and obstructive lesion and thus
Медицинский журнал Западного Казахстана №4 (40) 2013 г.
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to perform a retroscopy when looking back toward the distal part of the stenosis. Virtual bronchoscopy is applied increasingly for the evaluation of the airways, especially to detect airway stenoses [51]. Some authors suggest that virtual bronchoscopy is found to be highly accurate in the detection of central airway stenosis and to correlate closely with bronchoscopy in grading bronchial stenosis. But, we must never forget that virtual endoscopy is unable to identify the causes of bronchial obstruction: mild stenosis, submucosal infiltration, and superficial spreading tumours cannot identify.
Bronchial stenosis and strictures are irreversible in most cases, in connection with common and delayed complications of endobronchial tuberculosis, occuring in spite of adequate anti-tuberculosis treatment. Bronchial stenosis may develop to 95% in 60 cases and may even involve the main stem bronchi. Worst outcome can be the development of airway obstruction due to involvement of the trachea [52]. Bronchiectasis is also a common complication of endobronchial tuberculosis and develops as paracicatricial process, secondary to pulmonary destruction and fibrosis [53]. It also may be result from bronchial stenosis and distal bronchial dilatation. Bronchial strictures are induced during the active phase of endobronchial tuberculosis and by the cicatrization phase of nonspecific granular tissue formation after healing of tuberculous bronchitis following antituberculous treatment [54].
Differential diagnosis
Lung cancer is the most important differential diagnosis [55]. In some cases bronchial stenosis is due to endobronchial tuberculosis presenting as complication of lung cancer [56]. Recently cases of a combination of tuberculosis and cancer in one lobe of a lung have become frequent [57]. FOB with cytomorphological investigation can reveal origin causes of bronchial stenosis [58]. Also sarcoidosis involves to the bronchi and may manifest with endobronchial inflammation closely resembling endobronchial tuberculosis [59]. Bronchial stenosis due to sarcoidosis that may develop in certain cases needs to be differentiated from endobronchial tuberculosis carefully.
Diagnosis of bronchial stenoses still keeps the importance. Diagnosis of stenosis of the large bronchi is based on an integrated approach involving X-ray computer and endoscopic methods of examination. Bronchological methods of research find the increasing distribution in diagnosis and differential diagnosis of endobronchial tuberculosis, as initiators of bronchial stenosis. It is important to mention the positive role of the use of methods of endobronchial biopsies.
1. Алексеев О.Е., Глазунов А.В., Токарев П.Ф. Изменения бронхов при туберкулезе легких / Материалы VII Российского съезда фтизиаторов (Туберкулез сегодня). 2003, с.307.
2. Соколов В.А., Савельев А.В., Красноборова С.Ю. и др. Комплексная лучевая и эндоскопическая диагностика поражений легких при наличии стенозов бронхов // Проблемы туберкулеза, 2009, №2, с.11-12.
3. Шестерина М.В., Залимханов М.Г Фибробронхоскопия в диагностике посттуберкулезных стенозов бронхов // Проблемы туберкулеза, 2011, №5, с.17-20.
4. Kashyap S., Mohapatra R.P., Saini V. Endobronchial tuberculosis // Indian J Chest Diseases and Allied Sciences, 2003; vol 45; P. 247-256.
5. Haponik E.F., Aquino S.L., Vining D.J. Virtual bronchoscopy // Flexible bronchoscopy in the 21st century, 1999; vol 20; no 1; P. 201-217.
6. Hoppe H., Walder B., Sonnenschein M. et all. Multidetector CT virtual bronchoscopy to grade trachebronchial stenosis // American J Roentgen, 2002; 178; P. 1195-1200.
7. Lee K.W., Im J.G., Han J.K. et all. Tuberculous stenosis of the left main bronchus: results of treatment with balloons and stents // J Vasc Interv Radiol, 1999; 10; P. 352-358.
8. Селизарова Е.М., Судомоин Д.С., Табанакова И.А. Активный туберкулез бронхов при туберкулезе органов дыхания // Проблемы туберкулеза и болезней легких, 2003, №10, с.16-17.
9. Choe K.O., Jeong H.J., Sohn H.Y. Tuberculous bronchial stenosis: CT findings in 28 cases // American Journal of Roentgenology, 2000; 155; P. 971-976.
10. Shim Y.S. Endobronchial tuberculosis // Respirology, 2006; 1; P. 95-106.
11. Smith L.S., Schillaci R.F., Sarlin R.F. Endobronchial tuberculosis. Serial Fiberoptic bronchoscopy and natural history // Chest, 2007; 91; P. 644-647.
12. Lee Y.H., Sin Fai, Lam K.N. Endobronchial tuberculosis simulating bronchial asthma // Singapore Med J, 2004; 45 (8); P. 390-392.
Complication
Conclusion
References
42
13. Chang S.C., Lee P.Y., Perng R.P. Clinical role of bronchoscopy in adults with intrathoracic tuberculous lymphadenopathy // Chest, 2008; 93; P. 314-317.
14. Mariotta S., Guidi L., Aquilini M. et al. Airway stenosis after tracheo-bronchial tuberculosis // Respiratory medicine., 2007, vol 91, P. 107-110.
15. Lee J.H., Park S.S., Lee H.D. et all. Endobronchial tuberculosis: Clinical and bronchoscopic features in 121 cases // Chest, 2012; 102; P. 990-994.
16. Harris B., Lowy F.D., Stover D.E., Arcasoy S.M. Diagnostic bronchoscopy in solid-organ and hematopoetic stem cell transplantation // Annals of the American Thoracic Society, vol 10, No 1, 2013, P. 39-49.
17. Стадникова А.В. Аденогенный бронхо-легочный туберкулез у взрослых // Украинский пульмонологический журнал, 2002, №4, с.65-66.
18. Chung H.S., Lee J.H. Bronchoscopic assessment of the evolution of endobronchial tuberculosis // Chest, 2000; 117; P. 385-392.
19. Hales C.M., Heilig C.M., Chaisson R., et all. The association between symptoms and microbiologically defined response of tuberculosis treatment // Annals of the American Thoracic Society, vol 10, No 1, 2013, P. 18-25.
20. Mariotta S., Masullo M., Guidi L. et all. Tracheobronchial involvement in 84 cases of pulmonary tuberculosis // Monaldi arch chest dis., 2005, vol 50, No 5, P. 356-359.
21. Saleemi S., Khalid M., Zeituni M., Al-Dammas S. Tuberculosis presenting as endobronchial tumor // Saudi Medical Journal, 2004; vol 25 (8); P. 1103-1105.
22. Bekhara R., Beamis J., Simoff M., et all. Practice and complications of flexible bronchoscopy with biopsy procedures // Journal of Bronchology, 2005, vol 12, no 3, P. 139-142.
23. Hoheisel G., Teschler H., Chan B.K.M. et all. Roentgenological findings in endobronchial tuberculosis // Pneumologie, 2004, vol 48, P. 788-792.
24. Milam M.G., Evins A.E., Sahn S.A. Immediate chest roentgenography following fiberoptic bronchoscopy // Chest., 2009; 96: P. 477-479.
25. Власов П.В. Рентгенодиагностика туберкулеза органов дыхания. Часть I // Медицинская визуализация, 2004, №4, с.77-89.
26. Ратобыльский Г.В. Лучевые методы выявления и диагностики туберкулеза сегодня // Проблемы туберкулеза и болезней легких, 2004, №4, с.3-6.
27. Светышева Ж.А., Иоффе Л.Ц., Рехтман А.Г. Диагностическая и оперативная эндоскопия при органических стенозах трахеи и крупных бронхов // Грудная хирургия, 2007, №6, с.47-52
28. Low S-Y, Hsu A., Eng P. Interventional bronchoscopy for tuberculous tracheobronchial stenosis // Eur Resp J, sep 2004; 24; P. 345-347.
29. William L. Introduction of the flexible bronchoscope // J Bronchology, 2005, vol 12, no 4, P. 189-190.
30. Hoheisel G., Chan B.K.M., Chan C.H.S. et all. Endobronchial tuberculosis: diagnosis features and therapeutic outcome // Respiratory Medicine, 2004; 88; P. 593-597.
31. Poe R.H., Israel R.H. Flexible fiberoptic bronchoscopy in 1998 // Respiratory Care, 2008; 43: P. 811-819.
32. Fulkerson W.J. Current concepts. Fiberoptic bronchoscopy // New England J Med., 1984; 311: P. 511-515.
33. Chung M.P., Lee K.S., Han J. et all. Bronchial stenosis due to anthracofibrosis // Chest, 1998, 113; P. 344-350.
34. Zaid B., Rizvi N., Husain M., Hassan S.S. An audit of 191 fibreoptic bronchoscopies // J Coll Physicians Surg Pakistan, 2007, vol 7, No 2, P.64-66.
35. Thomas E.D. Fiberoptic bronchoscopy: an overview // Respir Ther, 2011; 11; P. 77-81.
36. Altin S., Cikrikcioglu S., Morgul M. et all. Fifty endobronchial tuberculosis cases based on bronchoscopic diagnosis // Respiration, 2007; 64; 2; P. 162-164.
37. Straddling P. Diagnostic Bronchoscopy. Fourth edn. Edinburg, London, Melbourne and New York: Churchill Livingstone, 2011. P. 439.
38. Naidich D.P., Lee J.J., Garay S.M. et all. Comparison of CT and fiberscopic bronchoscopy in the evaluation bronchial disease // America J Roent, 2007; 148; P. 1-7.
39. Lee J.H., Chung H.S. Bronchoscopic, radiologic and pulmonary function evoluation of endobronchial tuberculosis // Respirology, 2000; 5; P. 411-417.
40. Никитина Л.И., Дорох Е.А. Возможности современных технологий компьютерной томографии в диагностике заболеваний легких // Новости лучевой диагностики, 2000, №2, приложение: с.30
Медицинский журнал Западного Казахстана №4 (40) 2013 г.
43
41. Портной Л.М., Сташук Г.А. Рентгеновская компьютерная томография в диагностике туберкулеза легких // Проблемы туберкулеза, 2009, №4, с.16-21.
42. Пасейшвили Г.Ю., Александрович В.Л., Жоха К.К. Возможности компьютерной томографии в диагностике заболеваний легких // Новости лучевой диагностики, 2000, №2, приложение: с.30-31.
43. Слапик С.С., Давидович Т. В. Приоритеты использования метода компьютерной томографии в диагностике заболеваний органов грудной клетки // Новости лучевой диагностики, 2000, №1, с.20-22.
44. Кукуня Л.А. Трехмерная визуализация в компьютерной томографии: взгляд в будущее // Украинский медицинский журнал, 2000, №3 (17), с.84-86.
45. Hoppe H., Dinkel H.P., Walder B. et all. Grading airway stenosis down to the segmental level using virtual bronchoscopy // Chest, 2004; 125; P. 704-711.
46. Ferretti G.R., Bricault I., Coulomb M. Virtual tools for imaging of the thorax // European Respiratory Journal, 2001; 18; P. 381-392.
47. Ferretti G.R., Knoplioch J., Bricault I. et all. Central airway stenoses: preliminary results of spiral-CT-generated virtual bronchoscopy simulations in 29 patients // European Radiology, 1997; 7; P. 854-859.
48. Grenier P.A., Biegelman C. Spiral CT of the bronchial tree. In: Remy-Jardin M, Remy J (eds). Medical radiology spiral CT of the chest. Berlin Heidelberg, New York, 2006, Springer, P. 132-149.
49. Grenier P.A., Biegelman-Aubry C., Fetita C. et all. New frontiers in CT imaging of airway disease // European Radiology, 2002; 12; P. 1022-1044.
50. Vining D.J., Liu K., Choplin R.H., Haponik E.F. Virtual bronchoscopy: relationship of virtual reality endobronchial simulations to actual bronchoscopic findings // Chest, 2006; 109; P. 549-553.
51. Remy-Jardin M., Remy J., Deschildre F. et al. Obstructive lesions of the central airways: evaluation by using spiral CT with multiplanar and three-dimensional reformations // Eur Radiol, 2006; 6; P. 807-816.
52. Hsu H.S., Hsu W.H., Huang B.S. et al. Surgical treatment of endobronchial tuberculosis // Scandinavian Cardiovasc Journal, 2007; 31; P. 79-82.
53. Dumon J.F., Reboud E., Garbe L., Aucomte F., Meric B. Treatment of tracheobronchial lesions by laser photoresection // Chest, 2002; 81; P. 278-284.
54. Kato R., Kakizaki T., Hangai N., et all. Bronchoplastic procedures for tuberculous bronchial stenosis // J Thorac. Card. vasc Surg, 2003; 106; P. 1118-1121.
55. Goodman G.E. Lung cancer: prevention of lung cancer // Thorax, 2002; 57; P. 994-999.
56. Matthews J.I., Matarese S.L., Carpenter J.L. Endobronchial tuberculosis simulating lung cancer // Chest, 2004; 86; P. 642-644.
57. Подгаевская Т.П. Рак легких в сочетании с туберкулезом // Украинский медицинский журнал, 2001, №1 (21), с.96-101.
58. Yilmaz A., Uskul B., Duzgun S. et all. Cell type accuracy of bronchoscopic biopsy specimens in primary lung cancer // Turkish Resp J., 2000, vol 1, No 2, P. 16-19.
59. Udwadia Z.F., Pilling J.R., Jenkins P.F., Harrison B.D.W. Bronchoscopic and bronchographic findings in 12 patients with sarcoidosis and severe progressive airway obstruction // Thorax, 2010; 45; P. 272-275.
А.В. АЛИЕВ
БРОНХИАЛЬДЫ СТЕНОЗДЫН YДЕУIНЕ ЖАГДАЙ ЖАСАЙТЫН ЭНДОБРОНХИАЛЬДЫ ТУБЕРКУЛЕЗ
Губа орталыщ емханасы, 6зiрбайжан Денсаулыщ са^тау министрлп, 6зiрбайжан, Губа
Бронхиальды стеноз эндобронхиальды туберкулездщ салдары ретшде мазмундамамызга ар^ау болды. Эндобронхиальды туберкулездщ басталуы мYмкiн механизмдершщ екпе паренхимасыныц керштес за^ымдалуынан, жара жэне гиперплазданган кеудештк лимфа TYЙiндерiнщ ке^рдек сацылауына ^арай дYPДиюiнен жэне гематогендi жайылуынан ас^ынудыц ткелей ке^рдекке TYсуiн ^амтиды. Эндобронхиальды туберкулездщ ас^ынуыныц бiрi бронхиальды стеноз болып табылады.
Компьютерлк томография (КТ) мен бронхофиброскопия орталыщ тыныс алу жолдарын багалаудыц непзп
TYWH
44
эдiсi болып табылады. Кейбiр авторлар ^арапайым КТ-ны бронхоскопияга арналган жолнус^а ретiнде ^олдану диагностикальщ жагынан Yйлестiруге жэне терапияльщ емдеу шараларына квмектесетiндiгiне баса назар аударады. Виртуалды бронхоскопияньщ жогары тыныс алу жолдарынан вкпеге дейiнгi барльщ тыныс алу жолдары децгейлерЫщ жагдайын багалауга мYмкiндiгi бар.
Фздердщ назарларьщызга усынылган шолу ма^аласында элемнщ барльщ жерлерЫщ о^ымысты бронхологтары мен фтизиатрларыныц 10-жылдьщ тэжiрибесiн ^амтыган материал жиналып талданды.
Нег/'зг/ свздер: бронхиальды стеноз, тыныс алу жолдары, бронхоскопия, эндобронхиальды туберкулез.
РЕЗЮМЕ
А.В. АЛИЕВ
ЭНДОБРОНХИАЛЬНЫЙ ТУБЕРКУЛЕЗ, СПОСОБСТВУЮЩИЙ РАЗВИТИЮ БРОНХИАЛЬНОГО СТЕНОЗА
Губинская Центральная Больница, Министерство Здравоохранения Азербайджана, Азербайджан, Губа
Предметом нашего изложения является бронхиальный стеноз как следствие эндобронхиального туберкулеза. Возможные механизмы возникновения эндобронхиального туберкулеза включают прямое попадание заражения в бронх от смежного повреждения паренхимы легкого, эрозии и выпячивания гиперплазированного внутригрудного лимфатического узла в просвет бронха и гематогенное распространение. Одним из осложнений эндобронхиального туберкулеза является бронхиальный стеноз.
Компьютерная томография (КТ) и бронхофиброскопия - являются основными методами для оценки центральных дыхательных путей. Некоторые авторы подчеркивают, что использование обычной КТ, как гида для бронхоскопии, помогает оптимизации диагностического подхода и терапевтических процедур. Виртуальная бронхоскопия имеет потенциал для оценки состояния всех уровней дыхательных путей от верхних дыхательных путей до легкого.
В представленной вашему вниманию обзорной статье был собран и проанализирован материал, охвативший 10 -летнюю практику ученых бронхологов и фтизиатров со всего мира.
Ключевые слова: бронхиальный стеноз, дыхательные пути, бронхоскопия, эндобронхиальный туберкулез.
УДК 616.233-002.24-007.17.053.31
Б. TYCin^MEB
НЭРЕСТЕЛЕР ВРОНХ-0КПЕ ДИСПЛАЗИЯСЫ
Марат Оспанов атындагы Батыс Казахстан мемлекеттк медицина университету А^тебе
Аннотация. Дэрю ^азфп неонатология гылымыныц ец непзп мэселелершщ 6ipi - нэрестелер бронх-екпе дисплазиясына багышталган. ДД¥ усынысын бЬдщ елiмiз ^абылдап, т^ туылу жYкт¡л¡ктщ 22 аптасынан басталып есептелетЫ болганды^тан мацызы артып отыр. Дэрюте этиологиясы, патогенезу клиникасы, диагностикасы жэне емдеу мэселелер¡ ^арастырылган.
Вронх-екпе дисплазиясы (В0Д) - жаца туган, эс¡ресе, екпен¡ жасанды желденд¡ру ар^ылы оттепмен ем ^абылдаган шала туган, нэрестелерде дамитын созылмалы екпе ауруы (С0А). Аурудыц классикалыщ сипатын 1967 жылы Northway мен ^аламдастары бер¡п, РДС жэне респираторлы сYЙемелдеу жасалган шала туылган нэрестелердщ екпес¡ндег¡ гистологиялыщ жэне рентгенологиялыщ, клиникалыщ езгер¡стер¡н керсетт¡ [1,2]. 1979 жылы Bancalari мен оныц ^аламдастары аурудыц критериясы рет¡нде 28 ^ндк жэне одан жогары жасындагы оттег¡ге ^осымша ^ажетплк деп ^абылдап, Northway-дщ аны^тамасын жет¡лд¡рд¡. 1988 жылы Sherman екпенщ ауруыныц агымын на^ты багалау Yш¡н оттег¡ге тэуелд¡л¡кт¡ календарлыщ жас^а (28 кYн) байланысты емес, 36 апталыщ постконцептуальды (постменструальды) жасына байланысты пайдалануды усынды [3,4]. Бул езгер¡с Bancalari мен бас^алары енпзген, ете шала туылган сау нэрестелердщ санын азайтуга мYмк¡нд¡к тудырды. 2001 жылы Jobe пен Bancalari NIHD/NHLBI симпозиумда усынган Б©Д-ныщ аны^тамасы мен жктелюнщ соцгы модификациясы гестациялыщ жас^а (32 аптадан аз немесе 32 аптадан ас^ан) жэне аурудыц ауырлыгына нег¡зделген диагностикалыщ критерийлерге сYЙенед¡ [5,6]. Жумысшы топтыц шеш¡м¡мен «бронх-екпе дисплазиясы» диагнозы шала туылган жэне жетт туган жаца туган нэрестелердщ екпесшщ за^ымдалуына тэн деп са^талды. «Созылмалы екпе ауруы» термин¡ бул ауру Yш¡н бейарнамалы деп табылды [7,8].
Сурфактантпен емдеудщ рандомизирленген мультицен^ б¡рнеше зерттеулердщ сараптамасы Б0Д-сы (егер
Медицинский журнал Западного Казахстана №4 (40) 2013 г.
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