Nhau - Ungasarudza sei girazi revana bronchoscopy?

Historical kukura kwebronchoscopy

Pfungwa yakafara yebronchoscope inofanira kusanganisira bronchoscope yakaoma uye inoshanduka (inoshanduka) bronchoscope.

1897

Muna 1897, chiremba welaryngologist weGermany Gustav Killian akaita chirwere chekutanga chebronchoscopic munhoroondo - akashandisa endoscope yesimbi yakaoma kubvisa bony muviri wekunze kubva patrachea yemurwere.

1904

Chevalier Jackson muUnited States anogadzira bronchoscope yekutanga.

1962

Chiremba wechiJapan Shigeto Ikeda akagadzira yekutanga fiberoptic bronchoscope. Iyi inochinjika, microscopic bronchoscope, inongoyera mamirimita mashoma mudhayamita, inotapurirana mifananidzo kuburikidza nemakumi ezviuru zveoptical fibers, zvichiita kuti ipinde nyore muchikamu uye kunyange subsegmental bronchi. Kubudirira uku kwakabvumira vanachiremba kuti vaone zvimiro zvakadzika mukati memapapu kekutanga, uye varwere vaigona kushivirira kuongororwa pasi peanesthesia yemunharaunda, kubvisa kudiwa kweaneshesia. Kuuya kwefiberoptic bronchoscope kwakashandura bronchoscopy kubva pakuita zvekuvharisa kuenda pakuongorora kushoma, zvichibatsira kuvhenekwa kwezvirwere zvakaita sekenza yemapapu uye tibhii.

1966

Muna Chikunguru 1966, Machida akagadzira yekutanga yenyika yechokwadi fiberoptic bronchoscope. Muna Nyamavhuvhu 1966, Olympus yakagadzirawo yayo yekutanga fiberoptic bronchoscope. Pashure pacho, Pentax neFuji muJapan, uye Wolf muGermany, vakabudisawo mabronchoscopes avo.

Fiberoptic bronchoscope:

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

Compound bronchoscope:

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

Nhoroondo yevana bronchoscopy muChina

Kushandiswa kwekiriniki kwefiberoptic bronchoscopy muvana munyika yangu kwakatanga muna 1985, kwakapayona nezvipatara zvevana muBeijing, Guangzhou, Tianjin, Shanghai, uye Dalian. Tichivakira panheyo iyi, muna 1990 (yakavambwa zviri pamutemo muna 1991), Muzvinafundo Liu Xicheng, vachitungamirwa naProfessor Jiang Zaifang, vakagadzira kamuri rekutanga rekuChina revana bronchoscopy muchipatara cheBeijing Children's Hospital rakabatana neCapital Medical University, vachimaka kugadzwa zviri pamutemo kweChina yevana bronchoscopy tekinoroji system. Ongororo yekutanga yefiberoptic bronchoscopy mumwana yakaitwa neDhipatimendi Rekufema paChipatara cheVana chakabatana neZhejiang University School of Medicine muna 1999, zvichiita kuti ive imwe yemasangano ekutanga muChina kunyatsoita bvunzo dzefiberoptic bronchoscopy uye marapirwo muvana.

Tracheal dhayamita yevana pamazera akasiyana

Ungasarudza sei mhando dzakasiyana dzebronchoscopes?

Sarudzo yemhando yebronchoscope yevana inofanirwa kutariswa zvichienderana nezera remurwere, saizi yenzira yekufambisa mhepo, uye zvinotarisirwa kuongororwa uye kurapwa. Iyo "Nhungamiro yePediatric Flexible Bronchoscopy muChina (2018 Edition)" uye zvinhu zvine hukama ndizvo zvinongedzo zvekutanga.

Mhando dzebronchoscope dzinonyanya kusanganisira fiberoptic bronchoscopes, electronic bronchoscopes, uye musanganiswa bronchoscopes. Kune akawanda matsva emhando dzepamba pamusika, mazhinji acho ari emhando yepamusoro. Chinangwa chedu ndechekuwana muviri mutete, masimba makuru, uye mifananidzo yakajeka.

Mamwe mabronchoscopes anochinjika anounzwa:

Sarudzo yeMuenzaniso:

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

Inokodzera mapoka ese ezera (kusanganisira neonates). Parizvino pamusika mabronchoscopes ane madhayamita ekunze e2.5mm, 2.8mm, ne3.0mm, uye ane 1.2mm inoshanda chiteshi. Aya mabronchoscopes anogona kuita aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), laser dilatation, uye balloon dilatation ine 1mm dhayamita pre-dilatation chikamu uye simbi stents.

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

Nechepfungwa, izvi zvakakodzera vana vanopfuura gore rimwe chete. Yayo 2.0 mm inoshanda chiteshi inobvumira maitiro akadai se electrocoagulation, cryoablation, transbronchial tsono aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, uye stent kuiswa.

Olympus BF-MP290F ibronchoscope ine dhayamita rekunze re3.5 mm uye chiteshi 1.7 mm. Zano dhayamita yekunze: 3.0 mm (chikamu chekuisa ≈ 3.5 mm); dhayamita yemukati dhayamita: 1.7 mm. Inobvumira kupfuura kwe1.5 mm biopsy forceps, 1.4 mm ultrasound probes, uye 1.0 mm mabhurashi. Ziva kuti 2.0 mm dhayamita biopsy forceps haigone kupinda iyi chiteshi. Zvigadzirwa zvemumba seShixin zvinopawo zvakada kufanana. Fujifilm's next-generation EB-530P uye EB-530S series bronchoscopes ine ultra-thin scope ine dhayamita rekunze re 3.5 mm uye 1.2 mm yemukati dhayamita chiteshi. Izvo zvakakodzerwa kuongororwa uye kupindira kwezvipembenene zvemapapu emapapu mune zvose zvevana nevakuru. Iwo anowirirana ne 1.0 mm cytology mabhurashi, 1.1 mm biopsy forceps, uye 1.2 mm ekunze body forceps.

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

Kazhinji inokodzera vana vane makore masere uye kupfuura vanorema 35 kg kana kupfuura. Iyo 2.0 mm yekushanda chiteshi inobvumira maitiro akadai se electrocoagulation, cryoablation, transbronchial tsono aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, uye stent kuiswa. Mamwe mabronchoscopes ane chiteshi chekushanda chakakura kupfuura 2 mm, zvichiita kuti zvive nyore kune maitiro ekupindira.

Diameter

4. Nyaya dzinokosha: Ultrathin bronchoscopes ine dhayamita yekunze ye 2.0 mm kana 2.2 mm uye hapana chiteshi chekushanda chinogona kushandiswa kuongorora distal duku airways yevacheche vasati vasvika kana kuti vakazara. Izvo zvakakodzerwawo kuongororwa kwemhepo muvacheche vacheche vane yakanyanya airway stenosis.

Muchidimbu, muenzaniso wakakodzera unofanirwa kusarudzwa zvichienderana nezera remurwere, ukuru hwemhepo, uye kuongororwa uye kurapwa kunoda kuve nechokwadi chekubudirira uye kwakachengeteka nzira.

Zvimwe zvinhu zvekucherechedza pakusarudza girazi:

Kunyange zvazvo 4.0mm okunze dhayamita bronchoscopes akakodzera vana vanopfuura 1 gore, mukushanda chaiko, 4.0mm okunze dhayamita bronchoscopes zvakaoma kusvika yakadzika bronchial lumen yevana vane makore 1-2 okuberekwa. Naizvozvo, kuvana vari pasi pegore rimwe, 1-2 yemakore, uye huremu huri pasi pe15kg, dzakatetepa 2.8mm kana 3.0mm ekunze dhayamita bronchoscopes anowanzo shandiswa pakuita maoparesheni enguva dzose.

Kune vana vane makore 3-5 uye huremu 15kg-20kg, unogona kusarudza girazi rakatetepa rine dhayamita rekunze re 3.0mm kana girazi rine dhayamita rekunze re 4.2mm. Kana kufungidzira kuchiratidza kuti kune nzvimbo yakakura yeatelectasis uye sputum plug inogona kuvharika, zvinokurudzirwa kushandisa girazi rine dhayamita rekunze re 4.2mm kutanga, iro rine simba rinokwezva uye rinogona kusvetwa kunze. Gare gare, girazi rakatetepa 3.0mm rinogona kushandiswa kuchera zvakadzika uye kuongorora. Kana PCD, PBB, nezvimwewo zvichitariswa, uye vana vanotarisana nehuwandu hwepurulent secretions, zvinokurudzirwawo kusarudza girazi gobvu nehupamhi hwekunze hwe 4.2mm, iyo iri nyore kukwezva. Pamusoro pezvo, girazi rine dhayamita rekunze re3.5mm rinogona kushandiswa zvakare.

Kune vana vane makore mashanu kana kupfuura uye vanorema 20 kg kana kupfuura, bronchoscope yekunze ye4.2 mm ndiyo inowanzodiwa. Iyo 2.0 mm forceps chiteshi inogonesa kubata uye kuyamwa.

Nekudaro, yakatetepa 2.8/3.0 mm yekunze dhayamita bronchoscope inofanira kusarudzwa mumamiriro anotevera:

① Anatomical airway stenosis:

• Congenital kana postoperative airway stenosis, tracheobronchomalacia, kana extrinsic compression stenosis. • Mukati dhayamita ye subglottic kana narrowest bronchial segment <5 mm.

② Munguva pfupi yapfuura kukuvara kwemhepo kana edema

• Post-intubation glottic/subglottic edema, endotracheal burns, kana kukuvara kwekufema.

③ Kubata kwakanyanya kana kusagadzikana kwekufema

• Acute laryngotracheobronchitis kana kuti yakanyanya chimiro asthmaticus inoda kushatirwa kushoma.

④ Nasal nzira ine nhete yemhino maburi

• Yakakosha stenosis ye nasal vestibule kana yakaderera turbinate panguva yekuiswa kwemhino, kudzivirira kupfuura kwe4.2 mm endoscope pasina kukuvara.

⑤ Chinodiwa chekupinda mukati (giredhi 8 kana kupfuura) bronchus.
• Mune zvimwe zviitiko zveMycoplasma pneumonia yakaoma ine atelectasis, kana multiple bronchoscopic alveolar lavages in acute phase ichiri kutadza kudzorera atelectasis, endoscope yakanaka inogona kudiwa kuti iboore zvakadzika mudistal bronchoscope kuti iongorore uye kurapa zviduku, zvakadzika sputum plugs. • Muzviitiko zvinofungidzirwa zvebronchial obstruction (BOB), sequelae yemabayo akanyanya, fine endoscope inogona kushandiswa kurovera zvakadzika mumatavi uye ma subbranch echikamu chemapapu chakakanganisika. • Muzviitiko zvekuberekwa kwebronchial atresia, kuchera kwakadzika ne endoscope yakanaka kunodiwawo kune yakadzika bronchial atresia. • Pamusoro pezvo, mamwe maronda eparutivi (sekupararira kweropa realveolar uye peripheral nodules) anoda endoscope yakanaka.

⑥ Concomitant cervical kana maxillofacial deformities

• Micromandibular kana craniofacial syndromes (yakadai sePierre-Robin syndrome) inodzivirira nzvimbo ye oropharyngeal.

⑦ Nguva pfupi yekuita, inoda chete kuongororwa kwekuongorora

• Chete BAL, brushing, kana simple biopsy inodiwa; hapana zviridzwa zvakakura zvinodiwa, uye endoscope yakaonda inogona kuderedza kutsamwa.

⑧ Postoperative kutevera

• Recent rigid bronchoscopy kana bharumu dilatation kuderedza yechipiri mucosal trauma.

Muchidimbu:

"Stenosis, edema, kupfupika kwekufema, maburi madiki, kutenderera kwakadzika, kuremara, nguva pfupi yekuongorora, uye kupora mushure mekuvhiyiwa" - kana paine chero yeaya mamiriro aripo, chinja kune 2.8-3.0 mm mutete endoscope.

4. Kune vana vane makore> 8 makore uye kuyera> 35 kg, endoscope ine dhayamita yekunze ye4.9 mm kana yakakura inogona kusarudzwa. Zvisinei, nokuda kwebronchoscopy yenguva dzose, matete endoscopes haanyanyi kutsamwisa murwere uye kuderedza dambudziko rematambudziko kunze kwekunge kupindira kwakakosha kuchidiwa.

5. Fujifilm's current primary pediatric EBUS model ndiyo EB-530US. Zvinyorwa zvaro zvakakosha ndezvizvi: kureba kwekunze kwekunze: 6.7 mm, kuisa chubhu yekunze dhayamita: 6.3 mm, chiteshi chekushanda: 2.0 mm, kureba kwekushanda: 610 mm, uye urefu hwose: 880 mm. Zera uye uremu hunokurudzirwa: Nekuda kweiyo 6.7 mm kureba kweiyo endoscope, inokurudzirwa kuvana vane makore gumi nemaviri zvichikwira kana kurema > 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 yemakore, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 yemakore, ≥20 kg; kune vana vadiki, probe uye girazi madhayamita zvinoda kuderedzwa zvakare.

Nhanganyaya kune dzakasiyana-siyana bronchoscopy

Bronchoscopes inokamurwa zvinoenderana nechimiro chavo uye misimboti yekufungidzira muzvikamu zvinotevera:

Fiberoptic bronchoscopes

Electronic bronchoscopes

Yakasanganiswa bronchoscopes

Autofluorescence bronchoscopes

Ultrasound bronchoscopes

………

Fiberoptic bronchoscopy:

Electronic bronchoscope:

Compound bronchoscope:

Mamwe mabronchoscopes:

Ultrasound bronchoscopes (EBUS): An ultrasound probe yakabatanidzwa kumucheto wepamberi wemagetsi endoscope inozivikanwa se "airway B-ultrasound." Inogona kupinda mumadziro emhepo uye kunyatsoona mediastinal lymph nodes, tsinga dzeropa, uye mapundu kunze kwetrachea. Inonyanya kukodzera kune varwere vekenza yemapapu. Kuburikidza neiyo Ultrasound-inotungamirwa puncture, mediastinal lymph node samples inogona kuwanikwa nenzira kwayo kuona kana bundu racho raita metastasized, zvichigona kudzivirira kukuvadzwa kwechinyakare thoracotomy. EBUS yakakamurwa kuita "hombe EBUS" yekutarisa maronda akatenderedza nzira huru dzemhepo uye "diki EBUS" (ine peripheral probe) yekuona maronda emumapapu. Iyo "EBUS hombe" inoratidza zvakajeka hukama pakati pemitsipa yeropa, lymph nodes, uye nzvimbo-inobata maronda mukati me mediastinum kunze kwemhepo. Iyo zvakare inobvumira transbronchial tsono kushuvira zvakananga muronda pasi pekutarisa-chaiyo-nguva, kunyatso kudzivirira kukuvadzwa kwemidziyo mikuru yakatenderedza uye zvimiro zvemoyo, kuvandudza kuchengetedzeka uye kurongeka. Iyo "EBUS diki" ine mutumbi mudiki, ichibvumira kuti ione zvakajeka maronda emumapapu epamhepo apo mabronchoscopes akajairwa asingakwanisi kusvika. Kana yakashandiswa ne introducer sheath, inobvumira mamwe chaiwo sampling.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy inosanganisa akajairwa emagetsi bronchoscopes ane cellular autofluorescence uye ruzivo tekinoroji kuona maronda uchishandisa fluorescence mutsauko pakati pebundu maseru uye akajairwa maseru. Pasi pemasaisai chaiwo echiedza, maronda eprecancerous kana mapundu ekutanga anoburitsa fluorescence yakasarudzika inosiyana neruvara rwenyama yakajairika. Izvi zvinobatsira vanachiremba kuti vaone zvironda zvidiki zvinonetsa kuona neyakajairwa endoscopy, nekudaro zvichivandudza kukurumidza kuongororwa kwekenza yemapapu.

Ultra-yakaonda bronchoscopes:Ultra-thin bronchoscopes inyanzvi inoshanduka-shanduka ine dhayamita diki (kazhinji <3.0 mm). Iwo anonyanya kushandiswa kuongororwa chaiko kana kurapwa kwenzvimbo dzemapapu dziri kure. Mukana wavo wakakosha uri mukukwanisa kwavo kuona subsegmental bronchi pazasi nhanho 7, zvichiita kuti iwedzere kuongororwa kwezvironda zvisingaonekwi. Vanogona kusvika kubronchi diki iyo yakaoma kusvika neyechinyakare bronchoscopes, kuvandudza mwero wekuona kwekutanga maronda uye kuderedza kukuvadzwa kwekuvhiya.piyona wepamusoro-soro mu "navigation + robotics":kuongorora "uncharted territory" yemapapu.

Electromagnetic navigation bronchoscopy (ENB) yakafanana nekuisa bronchoscope neGPS. Preoperatively, 3D mapapu modhi inovakwa patsva uchishandisa CT scans. Panguva yekuvhiyiwa, tekinoroji yekumisikidza tekinoroji inotungamira endoscope kuburikidza neakaomarara matavi ebronchial, achinyatso kunanga madiki emapapu epamhepo anoyera mamirimita mashoma mudhayamita (senge pasi-girazi nodules pasi pe5 mm) ye biopsy kana ablation.

Robhoti-inobatsirwa bronchoscopy: Iyo endoscope inodzorwa neruoko rwerobhoti rwunoshandiswa nachiremba pane koni, kubvisa pesvedzero yekudengenyeka kwemaoko uye kuwana yakakwirira chinzvimbo. Mugumo we endoscope unogona kutenderera 360 madhigirii, ichibvumira kuchinjika kutenderera kuburikidza ne tortuous bronchial nzira. Iyo inonyanya kunyatsokodzera kushandura chaiko panguva yekuvhiyiwa kwakaoma kwemapapu uye yakatoita zvakakosha muminda yediki lung nodule biopsy uye ablation.

Mamwe mabronchoscopes epamba: