Nkhani - Momwe mungasankhire galasi la bronchoscopy ya ana?

Mbiri chitukuko cha bronchoscopy

Lingaliro lalikulu la bronchoscope liyenera kukhala ndi bronchoscope yolimba ndi bronchoscope yosinthika (yosinthika).

1897

Mu 1897, katswiri wa laryngologist wa ku Germany Gustav Killian anachita opaleshoni yoyamba ya bronchoscopic m'mbiri - adagwiritsa ntchito endoscope yachitsulo yolimba kuti achotse mafupa akunja kuchokera ku trachea ya wodwala.

1904

Chevalier Jackson ku United States amapanga bronchoscope yoyamba.

1962

Dokotala waku Japan Shigeto Ikeda adapanga bronchoscope yoyamba ya fiberoptic. Bronchoscope yosinthika iyi, yowoneka ngati mamilimita ochepa m'mimba mwake, imatumiza zithunzi kupyola masauzande a ulusi wowoneka bwino, zomwe zimapangitsa kuti zikhale zosavuta kuziyika mu segmental komanso ngakhale subsegmental bronchi. Kupambana kumeneku kunapangitsa madokotala kuti azitha kuyang'ana mkati mwa mapapu kwa nthawi yoyamba, ndipo odwala amatha kulekerera kuyesedwa kwa opaleshoni ya m'deralo, kuthetsa kufunika kwa anesthesia wamba. Kubwera kwa fiberoptic bronchoscope kunasintha bronchoscopy kuchoka ku njira yowononga kupita ku kafukufuku wocheperako, zomwe zimathandizira kuzindikira koyambirira kwa matenda monga khansa ya m'mapapo ndi chifuwa chachikulu.

1966

Mu Julayi 1966, Machida adapanga bronchoscope yoyamba yowona padziko lapansi. Mu Ogasiti 1966, Olympus idatulutsanso bronchoscope yake yoyamba ya fiberoptic. Pambuyo pake, Pentax ndi Fuji ku Japan, ndi Wolf ku Germany, adatulutsanso ma bronchoscopes awo.

Fiberoptic bronchoscope:

Olympus XP60, m'mimba mwake 2.8mm, biopsy channel 1.2mm

Mankhwala a bronchoscope:

Olympus XP260, m'mimba mwake 2.8mm, biopsy channel 1.2mm

Mbiri ya ana a bronchoscopy ku China

Kugwiritsiridwa ntchito kwachipatala kwa fiberoptic bronchoscopy kwa ana m'dziko langa kunayamba mu 1985, upainiya ndi zipatala za ana ku Beijing, Guangzhou, Tianjin, Shanghai, ndi Dalian. Pomanga pa maziko awa, mu 1990 (yomwe idakhazikitsidwa mu 1991), Pulofesa Liu Xicheng, motsogozedwa ndi Pulofesa Jiang Zaifang, adakhazikitsa chipinda choyamba cha ana ku China pachipatala cha ana cha Beijing chogwirizana ndi Capital Medical University, ndikuyika chizindikiro cha kukhazikitsidwa kwaukadaulo kwaukadaulo wa ana ku China. Kuyeza koyamba kwa fiberoptic bronchoscopy mwa mwana kunachitika ndi dipatimenti yopumira pa chipatala cha Ana chogwirizana ndi Zhejiang University School of Medicine mu 1999, zomwe zidapangitsa kuti ikhale imodzi mwamabungwe oyamba ku China kukhazikitsa mwadongosolo mayeso a fiberoptic bronchoscopy ndi chithandizo chamankhwala a ana.

Tracheal awiri a ana pa mibadwo yosiyana

Momwe mungasankhire mitundu yosiyanasiyana ya bronchoscopes?

Kusankhidwa kwa chitsanzo cha bronchoscope kwa ana kuyenera kutsimikiziridwa malinga ndi msinkhu wa wodwalayo, kukula kwa njira yodutsa mpweya, ndi matenda omwe amafunidwa ndi chithandizo. "Malangizo a Pediatric Flexible Bronchoscopy ku China (Kusindikiza kwa 2018)" ndi zida zofananira ndizo maumboni oyamba.

Mitundu ya bronchoscope makamaka imaphatikizapo ma bronchoscopes a fiberoptic, bronchoscopes zamagetsi, ndi ma bronchoscopes ophatikizika. Pali zatsopano zapakhomo pamsika, zambiri zomwe zimakhala zapamwamba kwambiri. Cholinga chathu ndikukwaniritsa thupi lochepa thupi, mphamvu zazikulu, ndi zithunzi zomveka bwino.

Ma bronchoscopes ena osinthika amayambitsidwa:

Kusankhidwa Kwachitsanzo:

1. Bronchoscopes ndi awiri a 2.5-3.0mm:

Ndioyenera kwa misinkhu yonse (kuphatikiza akhanda). Panopa pamsika ndi ma bronchoscope okhala ndi ma diameter akunja a 2.5mm, 2.8mm, ndi 3.0mm, komanso okhala ndi njira yogwirira ntchito 1.2mm. Ma bronchoscopes awa amatha kupanga aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), laser dilatation, ndi dilatation ya baluni ndi gawo la 1mm la pre-dilatation ndi zitsulo zachitsulo.

2. Ma bronchoscope okhala ndi mainchesi 3.5-4.0 mm:

Mwachidziwitso, izi ndizoyenera ana opitilira chaka chimodzi. Njira yake yogwirira ntchito ya 2.0 mm imalola njira monga electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), dilatation ya baluni, ndi kuika stent.

Olympus BF-MP290F ndi bronchoscope yokhala ndi mainchesi akunja a 3.5 mm ndi njira ya 1.7 mm. Nsonga m'mimba mwake: 3.0 mm (gawo lolowetsa ≈ 3.5 mm); njanji m'mimba mwake: 1.7 mm. Imalola kupita kwa 1.5 mm biopsy forceps, 1.4 mm ultrasound probes, ndi maburashi a 1.0 mm. Dziwani kuti 2.0 mm m'mimba mwake biopsy forceps sangathe kulowa mu njira iyi. Mitundu yakunyumba ngati Shixin imaperekanso zofananira. Ma bronchoscope a m'badwo wotsatira wa Fujifilm EB-530P ndi EB-530S amakhala ndi mawonekedwe owonda kwambiri okhala ndi mainchesi akunja a 3.5 mm ndi tchanelo chamkati cha 1.2 mm. Ndioyenera kuwunika ndikuwongolera zotupa zam'mapapo m'mapapo a ana komanso akuluakulu. Amagwirizana ndi maburashi a 1.0 mm cytology, 1.1 mm biopsy forceps, ndi mphamvu zakunja za 1.2 mm.

3. Ma bronchoscope okhala ndi mainchesi 4.9 mm kapena kupitilira apo:

Nthawi zambiri oyenera ana a zaka 8 ndi kupitirira masekeli 35 kg kapena kuposa. Njira yogwirira ntchito ya 2.0 mm imalola njira monga electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), dilatation ya baluni, ndi kuika stent. Ma bronchoscopes ena ali ndi njira yogwirira ntchito yokulirapo kuposa 2 mm, zomwe zimapangitsa kuti zikhale zosavuta kuchitapo kanthu.

Diameter

4. Milandu Yapadera: Ma Ultrathin bronchoscope okhala ndi mainchesi akunja a 2.0 mm kapena 2.2 mm ndipo palibe njira yogwirira ntchito yomwe ingagwiritsiridwe ntchito kuyang'ana mayendedwe ang'onoang'ono akutali a makanda obadwa msanga kapena a nthawi yonse. Ndiwoyeneranso kuyezetsa njira yapanjira kwa ana aang'ono omwe ali ndi vuto la airway stenosis.

Mwachidule, chitsanzo choyenera chiyenera kusankhidwa malinga ndi msinkhu wa wodwalayo, kukula kwa mpweya, ndi matenda ndi chithandizo chofunikira kuti zitsimikizire kuti njira yabwino ndi yotetezeka.

Nazi zina zofunika kuziwona posankha galasi:

Ngakhale 4.0mm akunja m'mimba mwake bronchoscopes ndi oyenera ana oposa 1 chaka, kwenikweni ntchito, 4.0mm kunja awiri bronchoscopes n'zovuta kufika kwambiri bronchial lumen ana a zaka 1-2. Choncho, ana osakwana chaka chimodzi, wazaka 1-2, ndi masekeli ochepera 15kg, ma bronchoscopes woonda 2.8mm kapena 3.0mm akunja awiriwa amagwiritsidwa ntchito popanga maopaleshoni wamba.

Kwa ana a zaka 3-5 ndi masekeli 15kg-20kg, mukhoza kusankha galasi woonda ndi awiri akunja awiri a 3.0mm kapena galasi ndi m'mimba mwake akunja 4.2mm. Ngati kujambula kukuwonetsa kuti pali malo ambiri a atelectasis ndipo pulagi ya sputum ndiyotheka kutsekedwa, tikulimbikitsidwa kugwiritsa ntchito galasi lokhala ndi mainchesi akunja a 4.2mm, lomwe limakopa kwambiri ndipo limatha kuyamwa. Pambuyo pake, galasi lopyapyala la 3.0mm lingagwiritsidwe ntchito pobowola mozama ndikufufuza. Ngati PCD, PBB, ndi zina zotero zimaganiziridwa, ndipo ana amatha kukhala ndi zotupa zambiri za purulent, tikulimbikitsidwanso kusankha galasi lakuda ndi lakunja la 4.2mm, lomwe ndi losavuta kukopa. Kuphatikiza apo, galasi yokhala ndi m'mimba mwake ya 3.5mm ingagwiritsidwenso ntchito.

Kwa ana azaka zisanu kapena kuposerapo ndi kulemera kwa 20 kg kapena kupitirira apo, bronchoscope yakunja ya 4.2 mm ndiyo imakonda. Njira ya 2.0 mm forceps imathandizira kusintha ndi kuyamwa.

Komabe, bronchoscope yocheperako ya 2.8/3.0 mm yakunja iyenera kusankhidwa muzochitika izi:

① Anatomical airway stenosis:

• Congenital or postoperative airway stenosis, tracheobronchomalacia, kapena extrinsic compression stenosis. • Mkati mwake wa subglottic kapena yopapatiza kwambiri bronchial gawo <5 mm.

② Zowopsa zaposachedwa zapanjira yapanjira kapena edema

• Post-intubation glottic/subglottic edema, kutentha kwa endotracheal, kapena kuvulala kopumira.

③ Kuthamanga kwambiri kapena kupuma movutikira

• Acute laryngotracheobronchitis kapena matenda a asthmaticus omwe amafuna kupsa mtima pang'ono.

④ Njira ya m'mphuno yokhala ndi mphuno yopapatiza

• Kutsika kwakukulu kwa mphuno yam'mphuno kapena pansi pa turbinate panthawi yolowetsa mphuno, kuteteza kutuluka kwa 4.2 mm endoscope popanda kuvulala.

⑤ Kufunika kolowera m'mphepete (giredi 8 kapena kupitilira apo) bronchus.
• Nthawi zina chibayo chachikulu cha Mycoplasma ndi atelectasis, ngati ma bronchoscopic alveolar lavages mu gawo lachimake akalephera kubwezeretsa atelectasis, endoscope yabwino ingafunike kubowola mozama mu distal bronchoscope kuti mufufuze ndi kuchiza mapulagi ang'onoang'ono a sputum. • Pa milandu yomwe ikuganiziridwa kuti ndi ya bronchial obstruction (BOB), chotsatira cha chibayo choopsa, endoscope yabwino ingagwiritsidwe ntchito kubowola mozama mu ting'onoting'ono ndi ting'onoting'ono ta gawo lomwe lakhudzidwa ndi mapapo. • Pankhani ya congenital bronchial atresia, kubowola mozama ndi endoscope yabwino ndikofunikiranso pakuzama kwa bronchial atresia. • Kuonjezera apo, zilonda zina za m'mphepete (monga kukha mwazi kwa alveolar ndi zotumphukira) zimafuna endoscope yabwino kwambiri.

⑥ Kupunduka kwa khomo lachiberekero kapena maxillofacial

• Micromandibular kapena craniofacial syndromes (monga Pierre-Robin syndrome) yoletsa malo oropharyngeal.

⑦ Nthawi yochepa ya ndondomeko, yomwe imafunika kufufuza kokha

• BAL, brushing, kapena biopsy yosavuta ndiyo imafunika; palibe zida zazikulu zomwe zimafunikira, ndipo endoscope yopyapyala imatha kuchepetsa kuyabwa.

⑧ Kutsatira pambuyo pa opaleshoni

• Posachedwapa olimba bronchoscopy kapena baluni dilatation kuchepetsa yachiwiri mucosal zoopsa.

Mwachidule:

"Stenosis, edema, kupuma movutikira, ming'oma ting'onoting'ono, m'mphepete mwakuya, kupunduka, nthawi yochepa yofufuza, ndi kuchira pambuyo pa opaleshoni" - ngati pali zina mwa izi, sinthani ku endoscope yopyapyala ya 2.8-3.0 mm.

4. Kwa ana azaka> 8 ndi kulemera> 35 kg, endoscope yokhala ndi mainchesi akunja a 4.9 mm kapena kupitilira apo ingasankhidwe. Komabe, kwa bronchoscopy yachizoloŵezi, ma endoscopes ochepa kwambiri samakwiyitsa wodwalayo ndipo amachepetsa chiopsezo cha zovuta pokhapokha ngati pakufunika thandizo lapadera.

5. Mtundu waposachedwa wa Fujifilm wa EBUS wa ana ndi EB-530US. Zofunikira zake zazikulu ndi izi: kutalika kwakunja kwakutali: 6.7 mm, kuyika chubu m'mimba mwake: 6.3 mm, njira yogwirira ntchito: 2.0 mm, kutalika kwa ntchito: 610 mm, ndi kutalika konse: 880 mm. Zaka zovomerezeka ndi kulemera kwake: Chifukwa cha kutalika kwa 6.7 mm kutalika kwa endoscope, akulimbikitsidwa kwa ana azaka 12 kapena kuposerapo kapena kulemera kwa 40 kg.

Olympus Akupanga Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 zaka, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 zaka, ≥20 kg; kwa ana aang'ono, probe ndi magalasi madiresi ayenera kuchepetsedwa.

Chiyambi cha bronchoscopy zosiyanasiyana

Ma bronchoscopes amagawidwa molingana ndi kapangidwe kawo ndi malingaliro awo m'magulu otsatirawa:

Fiberoptic bronchoscopes

Electronic bronchoscopes

Ma bronchoscopes ophatikizidwa

Autofluorescence bronchoscopes

Ultrasound bronchoscopes

………

Fiberoptic bronchoscopy:

Electronic bronchoscope:

Mankhwala a bronchoscope:

Ma bronchoscopes ena:

Ultrasound bronchoscopes (EBUS): Kafukufuku wa ultrasound wophatikizidwa kumapeto kwa endoscope yamagetsi amadziwika kuti "airway B-ultrasound." Imatha kulowa mumsewu wapanjira ndikuwona bwino ma lymph node a mediastinal, mitsempha yamagazi, ndi zotupa kunja kwa trachea. Ndizoyenera makamaka kwa odwala khansa ya m'mapapo. Kupyolera mu ultrasound-guided puncture, ma lymph node a mediastinal amatha kupezeka molondola kuti adziwe ngati chotupacho chafalikira, zomwe zingathe kupeŵa kuvulala kwa chikhalidwe cha thoracotomy. EBUS yagawidwa kukhala "EBUS yayikulu" poyang'ana zilonda zozungulira mayendedwe a mpweya ndi "EBUS yaying'ono" (yokhala ndi kafukufuku wam'mphepete) poyang'ana zotupa zam'mapapo. "EBUS yaikulu" ikuwonetseratu mgwirizano pakati pa mitsempha ya magazi, ma lymph nodes, ndi zotupa zokhala ndi malo mkati mwa mediastinum kunja kwa mpweya. Zimathandiziranso kulakalaka kwa singano ya transbronchial molunjika pachilonda pansi pakuyang'anira nthawi yeniyeni, kupewa kuwononga ziwiya zazikulu zozungulira ndi zida zamtima, kukonza chitetezo ndi kulondola. "EBUS yaying'ono" ili ndi thupi laling'ono, lomwe limalola kuti liziwona bwino zotupa zam'mapapo pomwe ma bronchoscopes wamba sangathe kufika. Mukagwiritsidwa ntchito ndi introducer sheath, imalola zitsanzo zolondola.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy imaphatikiza ma bronchoscopes apakompyuta ndi ma cell autofluorescence ndi ukadaulo wazidziwitso kuti azindikire zotupa pogwiritsa ntchito kusiyana kwa fluorescence pakati pa maselo otupa ndi maselo abwinobwino. Pansi pa kuwala kwapadera, zotupa za precancerous kapena zotupa zoyambilira zimatulutsa fulorosisi yapadera yomwe imasiyana ndi mtundu wa minofu yabwinobwino. Izi zimathandiza madokotala kuti azindikire zilonda zing'onozing'ono zomwe zimakhala zovuta kuzizindikira ndi endoscopy wamba, potero zimathandizira kuti azindikire khansa ya m'mapapo.

Ma bronchoscopes owonda kwambiri:Ma bronchoscopes owonda kwambiri ndi njira yosinthika kwambiri ya endoscopic yokhala ndi m'mimba mwake yaying'ono (nthawi zambiri <3.0 mm). Amagwiritsidwa ntchito pofufuza molondola kapena kuchiza madera a distal mapapo. Ubwino wawo waukulu wagona pakutha kuwona m'maganizo a subsegmental bronchi pansi pamlingo wa 7, zomwe zimapangitsa kufufuza mwatsatanetsatane za zotupa zosawoneka bwino. Amatha kufikira ma bronchi ang'onoang'ono omwe ndi ovuta kuwafikira ndi ma bronchoscopes achikhalidwe, kuwongolera kuchuluka kwa zotupa zoyambilira komanso kuchepetsa kuvulala kwa opaleshoni.Mpainiya wotsogola mu "navigation + robotics":kufufuza "gawo losadziwika" la mapapo.

Electromagnetic navigation bronchoscopy (ENB) ili ngati kukonzekeretsa chotchinga chamagetsi ndi GPS. Isanayambike, mtundu wa mapapo a 3D umamangidwanso pogwiritsa ntchito makina a CT. Panthawi ya opaleshoni, ukadaulo wa electromagnetic positioning ukadaulo umawongolera endoscope kudzera munthambi zovuta za bronchial, kulunjika ndendende tinthu tating'ono tating'ono ta m'mapapo tokhala ndi mamilimita ochepa m'mimba mwake (monga tinthu tating'onoting'ono tagalasi tapansi pa 5 mm) to biopsy kapena ablation.

Bronchoscopy yothandizidwa ndi roboti: Endoscope imayendetsedwa ndi mkono wa robotic woyendetsedwa ndi dokotala pa kontrakitala, kuthetsa kugwedezeka kwa manja ndikukwaniritsa malo olondola kwambiri. Mapeto a endoscope amatha kuzungulira madigiri 360, kulola kuyenda mosinthika kudzera munjira zowawa kwambiri za bronchial. Ndiwoyenera kwambiri kuwongolera bwino panthawi ya maopaleshoni ovuta a m'mapapo ndipo wakhudza kale gawo la tinthu tating'ono tating'onoting'ono ta m'mapapo ndi kutulutsa magazi.

Zina mwa bronchoscopes zapakhomo: