Nhau - Ungasarudza sei girazi rebronchoscopy yevana?

Kukura kwenhoroondo yebronchoscopy

Pfungwa yakakura ye bronchoscope inofanira kusanganisira rigid bronchoscope uye flexible (flexible) bronchoscope.

1897

Muna 1897, chiremba wepamuromo wekuGermany Gustav Killian akaita kuvhiyiwa kwekutanga kwebronchoscopy munhoroondo - akashandisa endoscope yesimbi yakaoma kubvisa muviri wekunze une mapfupa kubva mutrachea yemurwere.

1904

Chevalier Jackson muUnited States ndiye anogadzira bronchoscope yekutanga.

1962

Chiremba wekuJapan Shigeto Ikeda akagadzira bronchoscope yekutanga yefiberoptic. Iyi bronchoscope inochinjika, ine dhayamita shoma, yakatakura mifananidzo kuburikidza nemakumi ezviuru zvefibers dze optical, zvichiita kuti zvive nyore kuisa mu bronchi yezvikamu uye kunyange subsegmental. Kubudirira uku kwakabvumira vanachiremba kuona nemaziso zvivako zviri mukati memapapu kekutanga, uye varwere vaigona kutsungirira kuongororwa pasi peanesthesia yemunharaunda, zvichibvisa kudiwa kweanesthesia yakajairika. Kuuya kwe fiberoptic bronchoscope kwakachinja bronchoscopy kubva pakuvhiyiwa kweinvasive kuenda pakuongororwa kushoma, zvichiita kuti zvirwere zvakaita sekenza yemapapu neTB zviongororwe nekukurumidza.

1966

Muna Chikunguru 1966, Machida akagadzira bronchoscope yekutanga yepasi rose yefiberoptic. Muna Nyamavhuvhu 1966, Olympus yakagadzirawo bronchoscope yayo yekutanga yefiberoptic. Mushure mezvo, Pentax neFuji muJapan, uye Wolf muGermany, vakaburitsawo bronchoscope dzavo.

Bronchoscope yeFiberoptic:

Olympus XP60, dhayamita yekunze 2.8mm, chiteshi chebiopsy 1.2mm

Bronchoscope yakabatana:

Olympus XP260, dhayamita yekunze 2.8mm, chiteshi chebiopsy 1.2mm

Nhoroondo yebronchoscopy yevana muChina

Kushandiswa kwe fiberoptic bronchoscopy muvana munyika yangu kwakatanga muna 1985, kwakatangwa nezvipatara zvevana muBeijing, Guangzhou, Tianjin, Shanghai, neDalian. Vachivakira pahwaro uhwu, muna 1990 (yakagadzwa zviri pamutemo muna 1991), Purofesa Liu Xicheng, vachitungamirirwa naPurofesa Jiang Zaifang, vakavamba imba yekutanga yevana muChina yebronchoscopy paBeijing Children's Hospital yakabatana neCapital Medical University, zvichiratidza kuumbwa kwehurongwa hwehunyanzvi hwevana muChina. Kuongororwa kwekutanga kwe fiberoptic bronchoscopy mumwana kwakaitwa neDhipatimendi reKufema paChipatara cheVana chakabatana neZhejiang University School of Medicine muna 1999, zvichiita kuti ive imwe yezvikoro zvekutanga muChina kuita bvunzo dze fiberoptic bronchoscopy nekurapwa kwevana.

Upamhi hwetrachea yevana vemazera akasiyana

Ungasarudza sei mhando dzakasiyana dze bronchoscopes?

Sarudzo yemhando yebronchoscopy yevana inofanira kusarudzwa zvichienderana nezera remurwere, saizi yemhepo inofambisa mweya, uye kuongororwa kwaanoda kuitwa uye kurapwa. "Nhungamiro dzePediatric Flexible Bronchoscopy muChina (Chinyorwa cha2018)" nezvimwe zvinhu zvine chekuita nazvo ndizvo zvinonyanya kutaurwa.

Mhando dzeBronchoscope dzinosanganisira fiberoptic bronchoscopes, electronic bronchoscopes, uye combination bronchoscopes. Kune mhando itsva dzakawanda dzemuno dziri pamusika, dzakawanda dzacho dziri dzemhando yepamusoro. Chinangwa chedu ndechekuwana muviri mutete, forceps yakakura, uye mifananidzo yakajeka.

Mamwe ma bronchoscope anochinjika anoshandiswa:

Sarudzo yeModhero:

1. Mabhurokoskopu ane dhayamita ye2.5-3.0mm:

Yakakodzera mapoka ese ezera (kusanganisira vacheche). Parizvino ma bronchoscopes ane dhayamita yekunze ye2.5mm, 2.8mm, uye 3.0mm, uye ane chiteshi chinoshanda che1.2mm. Ma bronchoscopes aya anogona kuita aspiration, oxygenation, wavage, biopsy, brushing (fine-bristle), laser dilatation, uye balloon dilatation ine 1mm dhayamita pre-dilatation section uye metal stents.

2. Mabhurokoskopu ane dhayamita ye3.5-4.0 mm:

Panyaya yepfungwa, izvi zvakakodzera vana vanopfuura gore rimwe chete. Nzira yayo inoshanda ye2.0 mm inobvumira nzira dzakadai se electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), bharuni rakavhurika, uye stent placement.

Olympus BF-MP290F ibronchoscope ine dhayamita yekunze ye3.5 mm uye chiteshi che1.7 mm. Dhayamita yekunze yetip: 3.0 mm (chikamu chekuisa ≈ 3.5 mm); dhayamita yemukati yechiteshi: 1.7 mm. Inobvumira kupfuura kwe1.5 mm biopsy forceps, 1.4 mm ultrasound probes, uye 1.0 mm brushes. Cherechedza kuti 2.0 mm dhayamita biopsy forceps haigone kupinda muchiteshi ichi. Makambani emuno akaita seShixin anopawo mamwe matsanangudzo akafanana. Fujifilm's next-generation EB-530P uye EB-530S series bronchoscopes ine ultra-thin scope ine dhayamita yekunze ye3.5 mm uye 1.2 mm inner dayameter channel. Dzakakodzera kuongororwa nekupindira kwezvironda zvemapapu zveparutivi munzvimbo dzese dzevana nedzevakuru. Dzinoenderana nemabhurashi ecytology e1.0 mm, 1.1 mm biopsy forceps, uye 1.2 mm foreign body forceps.

3. Mabhurokoskopu ane dhayamita ye4.9 mm kana kupfuura:

Kazhinji yakakodzera vana vane makore masere zvichikwira uye vanorema 35 kg kana kupfuura. Nzira iyi inoshanda ye2.0 mm inobvumira nzira dzakadai se electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), bharuni rakavhurika, uye stent placement. Mamwe ma bronchoscopes ane nzira inoshanda yakakura kupfuura 2 mm, zvichiita kuti zvive nyore kuivhiya.

Dhayamita

4. Zvikamu Zvakakosha: Ma bronchoscope matete ane dhayamita yekunze ye2.0 mm kana 2.2 mm uye hapana nzira inoshanda inogona kushandiswa kuongorora nzira diki dzekufema dzevacheche vasati vasvika nguva kana kuti vacheche vakazara. Akakodzerawo kuongororwa nzira dzekufema muvacheche vadiki vane stenosis yakanyanya yemhepo.

Muchidimbu, modhi yakakodzera inofanira kusarudzwa zvichienderana nezera remurwere, saizi yemhepo inofambisa mweya, uye zvinodiwa pakuongororwa uye kurapwa kuti nzira yacho ibudirire uye yakachengeteka.

Zvimwe zvinhu zvekucherechedza pakusarudza girazi:

Kunyangwe hazvo ma bronchoscope ekunze ane dhayamita ye4.0mm akakodzera vana vane makore anopfuura 1, pakushanda chaiko, ma bronchoscope ekunze ane dhayamita ye4.0mm akaoma kusvika pa lumen yakadzika yebronchial yevana vane makore 1-2. Saka, kune vana vari pasi pegore rimwe, gore rimwe-2, uye vanorema pasi pe15kg, ma bronchoscope matete ane dhayamita ye2.8mm kana 3.0mm anowanzo shandiswa pakuita mabasa enguva dzose.

Kune vana vane makore 3-5 uye vanorema 15kg-20kg, munogona kusarudza girazi rakatetepa rine dhayamita yekunze ye3.0mm kana girazi rine dhayamita yekunze ye4.2mm. Kana mifananidzo ichiratidza kuti pane nzvimbo yakakura yeatelectasis uye sputum plug inogona kuvharika, zvinokurudzirwa kushandisa girazi rine dhayamita yekunze ye4.2mm kutanga, iro rine kukwezva kwakasimba uye rinogona kudhonzwa. Gare gare, girazi rakatetepa re3.0mm rinogona kushandiswa pakuboorera zvakadzama nekutsvaga. Kana PCD, PBB, nezvimwewo zvikafungwa, uye vana vachiwanzova nehuwandu hwakawanda hwemapurulent secretions, zvinokurudzirwawo kusarudza girazi gobvu rine dhayamita yekunze ye4.2mm, iri nyore kukwezva. Pamusoro pezvo, girazi rine dhayamita yekunze ye3.5mm rinogonawo kushandiswa.

Kune vana vane makore mashanu zvichikwira uye vane huremu hwemakirogiramu makumi maviri kana kupfuura, bronchoscope ine dhayamita yekunze ye4.2 mm ndiyo inonyanya kufarirwa. Nzira ye forceps ye2.0 mm inobatsira pakugadzirisa nekukweva.

Zvisinei, bronchoscope yakatetepa ine dhayamita yekunze ye 2.8/3.0 mm inofanira kusarudzwa mumamiriro ezvinhu anotevera:

① Kuoma kwenzira yekufema:

• Kuoma kwemhepo inobuda mushure mekuvhiyiwa kana mushure mekuvhiyiwa, tracheobronchomalacia, kana stenosis yekumanikidzwa kwekunze. • Dhayamita yemukati yechikamu chebronchial che subglottic kana chakamanikana kupfuura zvese <5 mm.

② Kukuvara kwemhepo ichangoburwa kana kuzvimba

• Kuzvimba kweganda mushure mekuiswa muchubhu, kutsva kwemudumbu, kana kukuvara kwekufema.

③ Kutambudzika kwakanyanya kwekufema kana kufema

• Kurwara kwakanyanya kwe laryngotracheobronchitis kana asthmaticus yakanyanya inoda kusanzwa kunorwadza zvishoma.

④ Nzira yemhino ine maburi matete emhino

• Kukanganiswa kwakanyanya kwenzvimbo yemhino kana turbinate iri pasi pemhino panguva yekuiswa kwemhino, zvichidzivirira kupfuura kwe endoscope ye 4.2 mm pasina kukuvara.

⑤ Zvinodiwa kuti upinde mubronchus yeropa (giredhi 8 kana kupfuura).
• Mune zvimwe zviitiko zveMycoplasma pneumonia yakanyanya ine atelectasis, kana mabhureki akawanda ebronchoscopy alveolar muchikamu cheacute achiri kutadza kudzorera atelectasis, endoscope yakanaka ingangodiwa kuti iboore zvakadzama mu distal bronchoscope kuti iongorore uye irape mapurasitiki madiki, akadzika. • Muzviitiko zvinofungidzirwa kuti bronchial obstruction (BOB), imwe yepneumonia yakaoma, endoscope yakanaka inogona kushandiswa kubooresa zvakadzama muzvikamu zvemapapu zvakakanganiswa. • Muzviitiko zve congenital bronchial atresia, kubooresa zvakadzama ne fine endoscope kunodiwawo pa deep bronchial atresia. • Pamusoro pezvo, mamwe maronda e peripheral diffuse (akadai se diffuse alveolar hemorrhage uye peripheral nodules) anoda fine endoscope.

⑥ Kuremara kwemuromo wechibereko kana maxillofacial pamwe chete

• Matambudziko emudumbu kana emusoro (akadai sePierre-Robin syndrome) anodzivisa nzvimbo yemuromo.

⑦ Nguva pfupi yekuvhiyiwa, inongoda kuongororwa kwechirwere chete

• BAL, kukwesha, kana biopsy zviri nyore zvinongodiwa chete; hapana michina mikuru inodiwa, uye endoscope diki inogona kuderedza kutsamwa.

⑧ Kutevera mushure mekuvhiyiwa

• Kukura kwebronchoscopy kana bharumu munguva pfupi yapfuura kuderedza kukuvara kwemucosal.

Muchidimbu:

"Kuoma kwemapfupa, kuzvimba, kufema zvishoma, tumaburi tudiki, periphery yakadzika, kuremara, nguva pfupi yekuongorora, uye kupora mushure mekuvhiyiwa"—kana paine chimwe chezvirwere izvi, chinja ushandise endoscope yakatetepa ye2.8–3.0 mm.

4. Kune vana vane makore anopfuura masere uye vane huremu hwe>35 kg, endoscope ine dhayamita yekunze ye4.9 mm kana kupfuura inogona kusarudzwa. Zvisinei, pakushandisa bronchoscopy yenguva dzose, endoscope dzakatetepa hadzinyanyi kutsamwisa murwere uye dzinoderedza njodzi yematambudziko kunze kwekunge paine kupindira kwakakosha.

5. Muenzaniso weFujifilm weEBUS wevana uripo parizvino iEB-530US. Tsanangudzo dzayo huru ndedzinotevera: dhayamita yekunze iri kure: 6.7 mm, dhayamita yekunze iri mukati mechubhu yekupinza: 6.3 mm, chiteshi chekushanda: 2.0 mm, kureba kwekushanda: 610 mm, uye kureba kwese: 880 mm. Zera nehuremu zvinokurudzirwa: Nekuda kwedhayamita yekunze iri kure ye6.7 mm ye endoscope, inokurudzirwa kuvana vane makore gumi nemaviri zvichikwira kana vanorema kupfuura 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥makore gumi nemaviri ekuberekwa, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥makore matanhatu ekuberekwa, ≥20 kg; kuvana vadiki, dhayamita yeprobe negirazi inofanira kuderedzwa zvakanyanya.

Nhanganyaya kune akasiyana-siyana mabronchoscopy

Mabronchoscopy anopatsanurwa zvichienderana nechimiro chawo uye misimboti yekufungidzira muzvikamu zvinotevera:

Mabhirosikopu eFiberoptiki

Mabhurokoskopu emagetsi

Mabhurokoskopu akasanganiswa

Mabhuronikopu eAutofluorescence

Mabhurokoskopu eUltrasound

……

Fiberoptic bronchoscopy: Kuongororwa kwebronchoscopy yeropa:

Bronchoscope yemagetsi:

Bronchoscope yakabatana:

Mamwe ma bronchoscopes:

Ultrasound bronchoscopes (EBUS): Chinoongorora ultrasound chakabatanidzwa muchikamu chepamberi che endoscope yemagetsi chinozivikanwa se "airway B-ultrasound." Chinogona kupinda mumadziro emhepo uye kuona zvakajeka mediastinal lymph nodes, mitsipa yeropa, uye bundu riri kunze kwe trachea. Chakakodzera zvikuru kuvarwere vane kenza yemapapu. Kuburikidza ne ultrasound-guided puncture, sampuli dze mediastinal lymph node dzinogona kuwanikwa nemazvo kuti zvionekwe kana bundu racho rapararira, zvichigona kudzivirira kukuvara kwe thoracotomy yechinyakare. EBUS yakakamurwa kuita "large EBUS" yekuona maronda akatenderedza nzira huru dzemhepo uye "small EBUS" (ine peripheral probe) yekuona maronda emapapu ari kunze. "Large EBUS" inoratidza zvakajeka hukama huripo pakati pemitsipa yeropa, lymph nodes, uye maronda anogara munzvimbo mukati me mediastinum kunze kwenzira dzemhepo. Inobvumirawo transbronchial netsono kusvetwa zvakananga muchironda ichiongororwa nenguva chaiyo, ichidzivirira kukuvara kwemidziyo mikuru yakapoteredza uye zvivakwa zvemwoyo, ichivandudza kuchengetedzeka uye kururama. "EBUS diki" ine muviri mudiki, zvichiita kuti ikwanise kuona zvakajeka maronda emapapu ari panze apo bronchoscopes isingasvike. Kana ikashandiswa nechinhu chinotanga kuburitsa ropa, inobvumira kutora sampuli zvakanyatsonaka.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy inosanganisa ma electronic bronchoscopes akajairwa ne cellular autofluorescence uye information technology kuti ione maronda achishandisa mutsauko we fluorescence pakati pemasero egomarara nemasero akajairwa. Pasi pema wavelength chaiwo echiedza, maronda asati aita kenza kana magomarara ekutanga anoburitsa fluorescence yakasiyana neruvara rwenyama yakajairwa. Izvi zvinobatsira vanachiremba kuona maronda madiki akaoma kuona ne endoscopy yakajairika, nokudaro zvichivandudza mwero wekuongorora kenza yemapapu pakutanga.

Mabhurokoskopu matete zvakanyanya:Ma bronchoscopes akatetepa zvakanyanya inzira ye endoscopic inochinjika ine dhayamita diki (kazhinji <3.0 mm). Anonyanya kushandiswa pakuongorora kana kurapa nzvimbo dzemapapu dziri kure. Chinhu chikuru chaanobatsira ndechekuti anogona kuona bronchi iri pasi pechikamu chechinomwe, zvichiita kuti zvikwanise kuongororwa zvakadzama kwezvironda zvidiki. Anogona kusvika kubronchi diki dzakaoma kusvika ne bronchoscopes dzechinyakare, zvichivandudza mwero wekuona zvironda pakutanga uye kuderedza kukuvara kwekuvhiyiwa.Muvambi wepamusoro mu "navigation + robotics":kuongorora "nzvimbo isina ruzivo" yemapapu.

Electromagnetic navigation bronchoscopy (ENB) yakafanana nekushandisa GPS pa bronchoscope. Pamberi pekuvhiyiwa, modhi yemapapu ye3D inogadzirwazve uchishandisa CT scans. Munguva yekuvhiyiwa, tekinoroji ye electromagnetic positioning inotungamira endoscope kuburikidza nematavi akaomarara ebronchial, ichinyatsotarisa matumbu madiki emapapu ane dhayamita yemamirimita mashoma (senge matumbu egirazi pasi pe5 mm) kuti iopiopy kana ablation.

Bronchoscopy inobatsirwa neRobhoti: Endoscope inodzorwa neruoko rwerobhoti runoshandiswa nachiremba panzvimbo yekuchengetera mapfupa, zvichibvisa simba rekudedera kwemaoko uye kuita kuti pave nekunyatsorongeka kwenzvimbo yacho. Mugumo weendoscope unogona kutenderera nemadhigirii mazana matatu nemakumi matanhatu, zvichibvumira kufamba nenzira dzinochinjika dzebronchial. Yakanyatsokodzera kugadziriswa kwakanyatsojeka panguva yekuvhiyiwa kwakaoma kwemapapu uye yakatove nemhedzisiro yakakura muminda ye biopsy yema nodules madiki emapapu uye ablation.

Mamwe ma bronchoscope epamba: