支气管结石症：基于近期五例患者病例系列的诊断与治疗见解

摘要(中文译文)

支气管结石（broncholithiasis）是指气管支气管树内存在钙化或骨化物质。这种罕见疾病在结核病和组织胞浆菌病流行地区报道较多，在这些地区，坏死性肉芽肿性淋巴结炎可导致营养不良性钙化，并最终使钙化淋巴结侵蚀进入支气管腔。临床表现异质性较大，从偶然发现到咯血、慢性咳嗽、反复感染以及梗阻后并发症均可出现。我们对在本三级医疗中心诊断为支气管结石的五例患者进行了回顾性分析。查阅临床记录，收集人口学特征、就诊症状、影像学表现、支气管镜干预措施、可获得的微生物学数据以及短期随访结局。两例患者主要以咯血就诊，一例表现为慢性咳嗽和严重感染性并发症，一例表现为反复肺炎和肺叶塌陷，另有一例因梗阻性支气管结石被偶然转诊。所有五例均通过支气管镜方式处理，联合使用了硬质或可弯曲支气管镜、异物钳、球囊扩张、冷冻治疗、局部止血措施，以及必要时氩等离子体凝固。两例患者还需要电视辅助胸腔镜手术处理脓胸，而非用于取出支气管结石本身。在可获得的情况下，微生物学发现包括混合霉菌，突显了梗阻后感染的风险。这些病例强调了支气管结石异质性的临床谱系，并支持将支气管镜作为经过适当选择患者的主要诊断和治疗方式。早期识别、多学科管理以及对相关感染性并发症的关注可能改善结局。

Abstract

Broncholithiasis refers to the presence of calcified or ossified material within the tracheobronchial tree. This rare condition is more frequently reported in regions endemic for tuberculosis and histoplasmosis, where necrotizing granulomatous lymphadenitis may lead to dystrophic calcification and eventual erosion of calcified lymph nodes into the bronchial lumen. Clinical presentation is heterogeneous and ranges from incidental findings to hemoptysis, chronic cough, recurrent infection, and post-obstructive complications. We conducted a retrospective review of five patients diagnosed with broncholithiasis at our tertiary care center. Clinical records were reviewed for demographic characteristics, presenting symptoms, imaging findings, bronchoscopic interventions, microbiologic data when available, and short-term follow-up outcomes. Two patients presented primarily with hemoptysis, one with chronic cough and severe infectious complications, one with recurrent pneumonia and lobar collapse, and one was incidentally referred with an obstructing broncholith. All five cases were managed bronchoscopically using combinations of rigid or flexible bronchoscopy, forceps, balloon dilation, cryotherapy, topical hemostatic measures, and argon plasma coagulation when needed. Two patients also required video-assisted thoracoscopic surgery for empyema management rather than for broncholith extraction itself. Where available, microbiologic findings included and mixed molds, highlighting the risk of post-obstructive infection. These cases underscore the heterogeneous clinical spectrum of broncholithiasis and support bronchoscopy as the primary diagnostic and therapeutic modality in appropriately selected patients. Early recognition, multidisciplinary management, and attention to associated infectious complications may improve outcomes.

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