Objective: To summarize the bronchoscopic features of transbronchial tuberculous mediastinal lymphadenitis and to observe the clinical efficacy of cryotherapy combined with drug infusion through bronchoscope.
Methods: Twenty-three cases of tuberculous mediastinal lymphadenitis diagnosed at Changhai Hospital were retrospectively analyzed. The bronchoscopic manifestations and the times, course, efficacy, complications and recurrence rate after treatment with cryotherapy combined with drug infusion were described.
Results: The mean age of the patients was (31 ± 10) years and the male to female ratio was 1:1.9. A total of 41 transmural lymph node lesions were found, usually after (3.4 ± 0.6) months with systemic anti-tuberculosis chemotherapy. The lesions occurred at the right side in 21 cases (60.98%). Endoscopic manifestations included caseous necrosis, granulomatous nodules, or both simultaneously, some lesions containing anthracotic substances. The median treatments of cryotherapy and drug infusion were 3 (1 - 6) times and 8 (6 - 11) times respectively. No significant difference was found between multiple lesions and single lesion group in the treatment of combination therapy. Therapeutic efficacy was 38/41 with improvement of bronchoscopic manifestations to smooth mucosa, lumen patency, mild anthracotic pigmentation or scar tissue. The rate of complications which included local bleeding and mediastinal bronchial fistula was 3.59%. No recurrence occurred in a long-term follow-up period.
Conclusion: Combination of cryotherapy and drug infusion through bronchoscope is a simple, safe and effective method to treat transbronchial tuberculous mediastinal lymphadenitis.