Kukula kwa mbiri ya bronchoscopy
Lingaliro lalikulu la bronchoscope liyenera kuphatikizapo bronchoscope yolimba komanso bronchoscope yosinthasintha (yosinthasintha).
1897
Mu 1897, katswiri wa za m'mero wa ku Germany, Gustav Killian, anachita opaleshoni yoyamba ya bronchoscopic m'mbiri - anagwiritsa ntchito endoscope yachitsulo cholimba kuti achotse thupi lachilendo lomwe linali ndi mafupa kuchokera ku trachea ya wodwalayo.
1904
Chevalier Jackson ku United States ndiye anapanga bronchoscope yoyamba.
1962
Dokotala waku Japan Shigeto Ikeda adapanga bronchoscope yoyamba ya fiberoptic. Bronchoscope yosinthasintha iyi, yokhala ndi mainchesi ochepa okha m'mimba mwake, idatumiza zithunzi kudzera mu ulusi wa kuwala zikwizikwi, zomwe zidapangitsa kuti zikhale zosavuta kuziyika mu bronchi ya magawo komanso ngakhale ya magawo ang'onoang'ono. Kupita patsogolo kumeneku kunalola madokotala kuwona mawonekedwe mkati mwa mapapo koyamba, ndipo odwala amatha kupirira kuyesedwa pansi pa anesthesia yakomweko, zomwe zidachotsa kufunikira kwa anesthesia wamba. Kubwera kwa bronchoscope ya fiberoptic kunasintha bronchoscopy kuchoka pa njira yolowerera kupita ku kafukufuku wocheperako, zomwe zidathandizira kuzindikira matenda oyamba monga khansa ya m'mapapo ndi chifuwa chachikulu.
1966
Mu Julayi 1966, Machida adapanga bronchoscope yoyamba padziko lonse lapansi ya fiberoptic. Mu Ogasiti 1966, Olympus idapanganso bronchoscope yake yoyamba ya fiberoptic. Pambuyo pake, Pentax ndi Fuji ku Japan, ndi Wolf ku Germany, adatulutsanso bronchoscope yawoyawo.
Bronchoscope ya fiberoptic:
Olympus XP60, mainchesi akunja 2.8mm, njira ya biopsy 1.2mm
Bronchoscope yophatikizana:
Olympus XP260, mainchesi akunja 2.8mm, njira ya biopsy 1.2mm
Mbiri ya bronchoscopy ya ana ku China
Kugwiritsa ntchito njira ya fiberoptic bronchoscopy mwa ana m'dziko langa kunayamba mu 1985, komwe kunayambitsidwa ndi zipatala za ana ku Beijing, Guangzhou, Tianjin, Shanghai, ndi Dalian. Pomanga maziko awa, mu 1990 (yomwe idakhazikitsidwa mwalamulo mu 1991), Pulofesa Liu Xicheng, motsogozedwa ndi Pulofesa Jiang Zaifang, adakhazikitsa chipinda choyamba cha ana ku China chophunzirira bronchoscopy ku Beijing Children's Hospital chomwe chimagwirizana ndi Capital Medical University, zomwe zidapangitsa kuti pakhale kukhazikitsidwa kwaukadaulo waukadaulo wa ana ku China. Kuyesa koyamba kwa fiberoptic bronchoscopy mwa mwana kunachitika ndi Dipatimenti Yothandizira Kupuma ku Chipatala cha Ana chomwe chimagwirizana ndi Zhejiang University School of Medicine mu 1999, zomwe zidapangitsa kuti ikhale imodzi mwa mabungwe oyamba ku China kukhazikitsa mayeso ndi chithandizo cha fiberoptic bronchoscopy mwa ana.
Kukula kwa trachea kwa ana azaka zosiyanasiyana
Kodi mungasankhe bwanji mitundu yosiyanasiyana ya bronchoscopes?
Kusankha chitsanzo cha bronchoscope ya ana kuyenera kutsimikiziridwa kutengera zaka za wodwalayo, kukula kwa mpweya wopuma, ndi matenda ndi chithandizo chomwe akufuna kupeza. "Malangizo a Pediatric Flexible Bronchoscopy ku China (Kope la 2018)" ndi zinthu zina zokhudzana nazo ndizo zizindikiro zazikulu.
Mitundu ya bronchoscope makamaka imaphatikizapo ma bronchoscope a fiberoptic, ma bronchoscope apakompyuta, ndi ma bronchoscope ophatikizana. Pali mitundu yatsopano yambiri yam'nyumba pamsika, yambiri yomwe ndi yapamwamba kwambiri. Cholinga chathu ndikupeza thupi lochepa thupi, mphamvu zazikulu, komanso zithunzi zomveka bwino.
Ma bronchoscope ena osinthasintha amayambitsidwa:
Kusankha Chitsanzo:
1. Ma bronchoscope okhala ndi mainchesi a 2.5-3.0mm:
Oyenera magulu onse azaka (kuphatikizapo akhanda). Pakadali pano pali ma bronchoscope okhala ndi mainchesi akunja a 2.5mm, 2.8mm, ndi 3.0mm, komanso okhala ndi njira yogwirira ntchito ya 1.2mm. Ma bronchoscope amenewa amatha kuchita aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), laser dilatation, ndi balloon dilatation yokhala ndi gawo la 1mm pre-dilatation ndi metal stents.
2. Ma bronchoscope okhala ndi mainchesi a 3.5-4.0 mm:
Mwachidziwitso, izi ndi zoyenera ana opitirira chaka chimodzi. Njira yake yogwirira ntchito ya 2.0 mm imalola njira monga electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, ndi stent placement.
Olympus BF-MP290F ndi bronchoscope yokhala ndi mainchesi akunja a 3.5 mm ndi njira ya 1.7 mm. M'mimba mwake wakunja: 3.0 mm (gawo lolowera ≈ 3.5 mm); m'mimba mwake wamkati: 1.7 mm. Imalola kudutsa kwa 1.5 mm biopsy forceps, 1.4 mm ultrasound probes, ndi maburashi a 1.0 mm. Dziwani kuti 2.0 mm diameter biopsy forceps sizingalowe mu njira iyi. Mitundu yakunyumba monga Shixin imaperekanso mafotokozedwe ofanana. Ma bronchoscope a Fujifilm a m'badwo wotsatira EB-530P ndi EB-530S ali ndi scope yopyapyala kwambiri yokhala ndi mainchesi akunja a 3.5 mm ndi njira yamkati ya mainchesi a 1.2 mm. Ndi oyenera kuwunika ndi kulowererapo kwa zilonda zam'mapapo m'malo onse a ana ndi akuluakulu. Amagwirizana ndi maburashi a cytology a 1.0 mm, 1.1 mm biopsy forceps, ndi 1.2 mm foreign body forceps.
3. Ma bronchoscope okhala ndi mainchesi a 4.9 mm kapena kupitirira apo:
Kawirikawiri ndi yoyenera ana azaka 8 ndi kupitirira apo kulemera kwa 35 kg kapena kuposerapo. Njira yogwirira ntchito ya 2.0 mm imalola njira monga electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, ndi stent placement. Ma bronchoscope ena ali ndi njira yogwirira ntchito yoposa 2 mm, zomwe zimapangitsa kuti zikhale zosavuta kugwiritsa ntchito njira zochizira.
M'mimba mwake
4. Mabokosi Apadera: Ma bronchoscope owonda kwambiri okhala ndi mainchesi akunja a 2.0 mm kapena 2.2 mm ndipo palibe njira yogwirira ntchito yomwe ingagwiritsidwe ntchito poyesa njira zazing'ono zopumira za makanda osakwana nthawi kapena obadwa nthawi zonse. Ndi oyeneranso kuwunikira njira zopumira mwa makanda aang'ono omwe ali ndi vuto lalikulu la stenosis ya njira zopumira.
Mwachidule, chitsanzo choyenera chiyenera kusankhidwa kutengera zaka za wodwalayo, kukula kwa mpweya wopuma, ndi zomwe akufunikira pozindikira komanso chithandizo kuti atsimikizire kuti njira yochizira ikuyenda bwino komanso yotetezeka.
Zinthu zina zofunika kuziganizira posankha galasi:
Ngakhale kuti ma bronchoscope akunja okwana 4.0mm ndi oyenera ana opitirira chaka chimodzi, pamene akugwira ntchito, ma bronchoscope akunja okwana 4.0mm ndi ovuta kufika ku lumen yakuya ya bronchial ya ana azaka zapakati pa 1-2. Chifukwa chake, kwa ana osakwana chaka chimodzi, chaka chimodzi-2, komanso olemera zosakwana 15kg, ma bronchoscope owonda akunja okwana 2.8mm kapena 3.0mm nthawi zambiri amagwiritsidwa ntchito pa ntchito zachizolowezi.
Kwa ana azaka zapakati pa 3-5 ndi kulemera kwa 15kg-20kg, mutha kusankha galasi lopyapyala lokhala ndi mainchesi akunja a 3.0mm kapena galasi lokhala ndi mainchesi akunja a 4.2mm. Ngati kujambula kukuwonetsa kuti pali malo ambiri a atelectasis ndipo pulagi ya sputum ikhoza kutsekedwa, ndikulimbikitsidwa kugwiritsa ntchito galasi lokhala ndi mainchesi akunja a 4.2mm poyamba, lomwe lili ndi chikoka champhamvu ndipo limatha kuyamwa. Pambuyo pake, galasi lopyapyala la 3.0mm lingagwiritsidwe ntchito pobowola mozama ndi kufufuza. Ngati PCD, PBB, ndi zina zotero zikuganiziridwa, ndipo ana ali ndi vuto lalikulu la kutulutsa mafinya, ndikulimbikitsidwanso kusankha galasi lopyapyala lokhala ndi mainchesi akunja a 4.2mm, lomwe ndi losavuta kukoka. Kuphatikiza apo, galasi lokhala ndi mainchesi akunja a 3.5mm lingagwiritsidwenso ntchito.
Kwa ana azaka 5 kapena kuposerapo omwe amalemera makilogalamu 20 kapena kuposerapo, bronchoscope ya 4.2 mm m'mimba mwake ndi yomwe nthawi zambiri imakondedwa. Njira ya 2.0 mm forceps imathandiza kuyendetsa ndi kuyamwa.
Komabe, bronchoscope yopyapyala ya 2.8/3.0 mm m'mimba mwake iyenera kusankhidwa pazochitika zotsatirazi:
① Kuvuta kwa mpweya wodutsa m'thupi:
• Kutupa kwa mpweya wobadwa nawo kapena wotuluka opaleshoni, tracheobronchomalacia, kapena stenosis ya extrinsic compression. • M'mimba mwake mwa gawo la subglottic kapena la bronchial lopapatiza kwambiri < 5 mm.
② Kuvulala kwaposachedwa kwa mpweya kapena kutupa
• Kutupa kwa glottic/subglottic pambuyo polowa m'chubu, kupsa kwa endotracheal, kapena kuvulala kwa kupuma.
③ Kuvutika kwambiri kwa stridor kapena kupuma
• Matenda a pakhosi otchedwa laryngotracheobronchitis kapena matenda oopsa a mphumu omwe amafunika kuyabwa pang'ono.
④ Njira ya mphuno yokhala ndi mphuno yopapatiza
• Kutsekeka kwakukulu kwa vestibule ya m'mphuno kapena inferior turbinate panthawi yoika m'mphuno, zomwe zimalepheretsa kupita kwa endoscope ya 4.2 mm popanda kuvulala.
⑤ Kufunika kolowera m'dera la bronchus (la giredi 8 kapena kupitirira apo).
• Nthawi zina matenda a chibayo chachikulu cha Mycoplasma ndi atelectasis, ngati ma bronchoscopic alveolar lavages ambiri mu gawo loopsa akulephera kubwezeretsa atelectasis, endoscope yopyapyala ingafunike kuti iboole mozama mu distal bronchoscope kuti ifufuze ndikuchiza ma sputum plugs ang'onoang'ono, akuya. • Ngati akuganiziridwa kuti bronchial obstruction (BOB), yomwe ndi zotsatira za chibayo chachikulu, endoscope yopyapyala ingagwiritsidwe ntchito kuboola mozama mu nthambi zazing'ono ndi zazing'ono za gawo la mapapo lomwe lakhudzidwa. • Ngati bronchial atresia yobadwa nayo, kuboola mozama ndi endoscope yopyapyala ndikofunikiranso pa deep bronchial atresia. • Kuphatikiza apo, zilonda zina zofalikira za m'mphepete mwa m'mimba (monga kufalikira kwa magazi m'mimba ndi ma nodule a m'mphepete mwa m'mimba) zimafuna endoscope yopyapyala.
⑥ Kufooka kwa khosi kapena nkhope komwe kumachitika nthawi imodzi
• Matenda a micromandibular kapena craniofacial syndromes (monga Pierre-Robin syndrome) omwe amaletsa malo olumikizirana mafupa.
⑦ Nthawi yochepa yochitira opaleshoni, yomwe imafuna kuyezetsa matenda okha
• BAL, kutsuka mano, kapena biopsy yokha ndiyo imafunika; palibe zida zazikulu zomwe zimafunika, ndipo endoscope yopyapyala imatha kuchepetsa kuyabwa.
⑧ Kutsatira pambuyo pa opaleshoni
• Kutambasuka kwa bronchoscopy kapena baluni posachedwapa kuti muchepetse kuvulala kwa mucosal kwachiwiri.
Mwachidule:
"Kutupa kwa mafupa, kutupa, kupuma movutikira, minyewa yaing'ono, kufooka kwa thupi, kufooka kwa thupi, nthawi yochepa yoyezetsa, komanso kuchira pambuyo pa opaleshoni"—ngati pali vuto lililonse mwa izi, sinthani ku endoscope yopyapyala ya 2.8–3.0 mm.
4. Kwa ana azaka zoposa 8 ndi kulemera kwa >35 kg, endoscope yokhala ndi mainchesi akunja a 4.9 mm kapena kuposerapo ingasankhidwe. Komabe, pa bronchoscopy yachizolowezi, endoscope zopyapyala sizimakwiyitsa wodwalayo ndipo zimachepetsa chiopsezo cha zovuta pokhapokha ngati pakufunika thandizo lapadera.
5. Chitsanzo chachikulu cha Fujifilm cha EBUS cha ana ndi EB-530US. Mafotokozedwe ake ofunikira ndi awa: m'mimba mwake wakunja: 6.7 mm, m'mimba mwake wakunja wa chubu cholowetsa: 6.3 mm, njira yogwirira ntchito: 2.0 mm, kutalika kwake: 610 mm, ndi kutalika konse: 880 mm. Zaka ndi kulemera kovomerezeka: Chifukwa cha m'mimba mwake wakutali wa endoscope wa 6.7 mm, ndikulimbikitsidwa kwa ana azaka 12 kapena olemera>40 kg.
Bronchoscope ya Olympus Ultrasonic: (1) Linear EBUS (BF-UC190F Series): Zaka ≥12, ≥40 kg. (2) Galasi Lozungulira la EBUS + Ultrathin (BF-MP290F Series): Zaka ≥6, ≥20 kg; kwa ana aang'ono, ma diameter a probe ndi galasi ayenera kuchepetsedwa kwambiri.
Chiyambi cha bronchoscopy zosiyanasiyana
Ma bronchoscopy amagawidwa m'magulu otsatirawa malinga ndi kapangidwe kake ndi mfundo zawo zojambulira:
Ma bronchoscope a fiberoptic
Ma bronchoscope apakompyuta
Ma bronchoscope ophatikizana
Ma bronchoscope a Autofluorescence
Ma bronchoscope a ultrasound
……
Fiberoptic bronchoscopy: Kufufuza kwa mafupa a mafupa:
Bronchoscope yamagetsi:
Bronchoscope yophatikizana:
Ma bronchoscope ena:
Ma Ultrasound bronchoscopes (EBUS): Choyezera cha ultrasound chomwe chili kutsogolo kwa endoscope yamagetsi chimadziwika kuti "airway B-ultrasound." Chimatha kulowa mu khoma la mpweya ndikuwona bwino ma lymph nodes a mediastinal, mitsempha yamagazi, ndi zotupa kunja kwa trachea. Ndi choyenera kwambiri kwa odwala khansa yamapapo. Kudzera mu ultrasound-guiling-led ultrasound, zitsanzo za ma lymph node a mediastinal zitha kupezeka molondola kuti zitsimikizire ngati chotupacho chafalikira, zomwe zingapewe kuvulala kwa thoracotomy yachikhalidwe. EBUS imagawidwa mu "EBUS yayikulu" yowonera zilonda kuzungulira njira zazikulu zopumira ndi "EBUS yaying'ono" (yokhala ndi choyezera cha m'mphepete) yowonera zilonda zam'mapapo. "EBUS yayikulu" ikuwonetsa bwino ubale pakati pa mitsempha yamagazi, ma lymph nodes, ndi zilonda zomwe zimakhala m'malo mkati mwa mediastinum kunja kwa njira zopumira. Imalolanso kutulutsa singano ya transbronchial mwachindunji mu chotupacho pansi pa kuyang'aniridwa nthawi yeniyeni, kupewa kuwonongeka kwa mitsempha yayikulu yozungulira ndi kapangidwe ka mtima, kukonza chitetezo ndi kulondola. "EBUS yaying'ono" ili ndi thupi laling'ono, zomwe zimapangitsa kuti ione bwino zilonda zam'mapapo zomwe sizingafikire ma bronchoscopes achikhalidwe. Ikagwiritsidwa ntchito ndi chidebe choyambira, imalola kuti pakhale zitsanzo zolondola kwambiri.
Kuyeza kwa fluorescence bronchoscopy: Kuyeza kwa immunofluorescence bronchoscopy kumaphatikiza ma bronchoscope amagetsi ndi ma cell autofluorescence ndi ukadaulo wazidziwitso kuti adziwe zilonda pogwiritsa ntchito kusiyana kwa fluorescence pakati pa maselo a chotupa ndi maselo abwinobwino. Pansi pa mafunde enieni a kuwala, zilonda zoyamba khansa kapena zotupa zoyambirira zimatulutsa kuwala kwapadera komwe kumasiyana ndi mtundu wa minofu yabwinobwino. Izi zimathandiza madokotala kuzindikira zilonda zazing'ono zomwe zimakhala zovuta kuzizindikira pogwiritsa ntchito endoscopy yachizolowezi, motero zimathandizira kuchuluka kwa matenda a khansa ya m'mapapo msanga.
Ma bronchoscope owonda kwambiri:Ma bronchoscope opyapyala kwambiri ndi njira yosinthika kwambiri yofufuzira matenda a endoscopic yokhala ndi mainchesi ochepa (nthawi zambiri <3.0 mm). Amagwiritsidwa ntchito makamaka pofufuza kapena kuchiza madera akutali a mapapo. Ubwino wawo waukulu uli ndi kuthekera kwawo kuwona bronchi yaing'ono yomwe ili pansi pa mulingo wa 7, zomwe zimathandiza kuti azitha kuwona bwino zilonda zazing'ono. Amatha kufikira bronchi yaying'ono yomwe ndi yovuta kufikako ndi ma bronchoscope achikhalidwe, kukulitsa kuchuluka kwa zilonda zoyambirira komanso kuchepetsa kuvulala kwa opaleshoni.Mpainiya wamakono mu "navigation + robotics":kufufuza "dera losadziwika" la mapapo.
Kufufuza kwa electromagnetic navigation bronchoscopy (ENB) kuli ngati kupatsa bronchoscope GPS. Asanayambe opaleshoni, chitsanzo cha mapapo cha 3D chimamangidwanso pogwiritsa ntchito CT scans. Pa opaleshoni, ukadaulo woika malo a electromagnetic umatsogolera endoscope kudzera mu nthambi zovuta za bronchial, polunjika bwino ku tinthu tating'onoting'ono ta m'mapapo tomwe tili ndi mainchesi ochepa okha (monga tinthu tagalasi lopanda pansi pa 5 mm) kuti tipeze biopsy kapena ablation.
Bronchoscopy yothandizidwa ndi roboti: Endoscope imayendetsedwa ndi mkono wa roboti womwe dokotala amagwiritsa ntchito pa console, kuchotsa mphamvu ya kugwedezeka kwa manja ndikupeza kulondola kwakukulu kwa malo. Mapeto a endoscope amatha kuzungulira madigiri 360, zomwe zimathandiza kuti munthu azitha kuyenda mosavuta kudzera m'njira zovuta za bronchial. Ndi yoyenera kwambiri pokonza molondola panthawi ya opaleshoni yovuta ya mapapo ndipo yakhala ikukhudza kwambiri m'magawo a biopsy ya tinthu tating'onoting'ono ta m'mapapo ndi ablation.
Ma bronchoscope ena apakhomo:
Kuphatikiza apo, mitundu yambiri yakunyumba monga Aohua ndi Huaguang ndi yabwinonso.
Tiyeni tiwone zomwe tingapereke ngati mankhwala ogwiritsira ntchito bronchoscopy
Nazi zinthu zathu zogwiritsidwa ntchito m'ma endoscopic zomwe zimagwirizana ndi bronchoscopy.
Mphamvu Zotayidwa za Biopsy1.8mm biopsy forcepspa bronchoscopy yogwiritsidwanso ntchito
1.0mm biopsy forcepskwa bronchoscopy yotayidwa
Nthawi yotumizira: Sep-03-2025