Akụkọ - Kedu otu esi ahọrọ enyo maka bronchoscopy ụmụaka?

Mmepe akụkọ ihe mere eme nke bronchoscopy

Echiche sara mbara nke bronchoscope kwesịrị ịgụnye bronchoscope siri ike na bronchoscope na-agbanwe (mgbanwe).

1897

Na 1897, German laryngologist Gustav Killian rụrụ mbụ bronchoscopic ịwa ahụ na akụkọ ihe mere eme - o ji a ike siri ike metal endoscope wepụ a ọkpụkpụ nke mba ọzọ ahụ na trachea onye ọrịa.

1904

Chevalier Jackson na United States rụpụtara bronchoscope mbụ.

1962

Dọkịta Japan bụ Shigeto Ikeda mepụtara bronchoscope nke mbụ fiberoptic. Nke a na-agbanwe agbanwe, microscopic bronchoscope, na-atụ naanị milimita ole na ole na dayameta, bufere onyonyo site na iri puku kwuru iri puku eriri anya, na-eme ka ntinye dị mfe n'ime akụkụ na ọbụna bronchi subsegmental. Ọganihu a nyere ndị dọkịta ohere ịhụ ihe owuwu dị n'ime akpa ume maka oge mbụ, ndị ọrịa nwere ike ịnabata nyocha ahụ n'okpuru mgbakasị mpaghara, na-ewepụ mkpa maka mgbanwụ izugbe. Ọbịbịa nke bronchoscope fiberoptic gbanwere bronchoscopy site na usoro mkpasu iwe gaa na nyocha nke ntanarị, na-eme ka nchọpụta mmalite nke ọrịa dị ka ọrịa cancer akpa ume na ụkwara nta.

1966

Na July 1966, Machida mepụtara bronchoscope mbụ nke fiberoptic n'ụwa. N'August 1966, Olympus mekwara bronchoscope nke mbụ fiberoptic. Mgbe e mesịrị, Pentax na Fuji na Japan, na Wolf na Germany, wepụtakwara bronchoscope nke ha.

Bronchoscope nke eriri afọ:

Olympus XP60, dayameta mpụta 2.8mm, ọwa biopsy 1.2mm

Bronchoscope mejupụtara:

Olympus XP260, dayameta mpụta 2.8mm, ọwa biopsy 1.2mm

Akụkọ banyere bronchoscopy ụmụaka na China

Iji ọgwụ fiberoptic bronchoscopy eme ihe n'ụlọ ọgwụ na ụmụaka nọ na mba m malitere na 1985, nke ụlọ ọgwụ ụmụaka dị na Beijing, Guangzhou, Tianjin, Shanghai, na Dalian sụrụ ụzọ. N'ịwube na ntọala a, na 1990 (nke e hibere na 1991), Prọfesọ Liu Xicheng, n'okpuru nduzi nke Prọfesọ Jiang Zaifang, guzobere ụlọ mbụ ụmụaka bronchoscopy nke China na ụlọ ọgwụ ụmụaka nke Beijing jikọtara ya na Mahadum Capital Medical University, na-akara akara nhazi nke usoro nkà na ụzụ nke ụmụaka bronchoscopy nke China. Nyocha mbụ nke fiberoptic bronchoscopy n'ime nwatakịrị mere site na Ngalaba iku ume na ụlọ ọgwụ ụmụaka jikọtara ya na ụlọ akwụkwọ nkà mmụta ọgwụ nke Zhejiang na 1999, na-eme ka ọ bụrụ otu n'ime ụlọ ọrụ mbụ na China iji mee ihe nyocha na ọgwụgwọ fiberoptic bronchoscopy n'usoro na ọgwụgwọ ụmụaka.

Dayameta tracheal nke ụmụaka na afọ dị iche iche

Kedu otu esi ahọrọ ụdị bronchoscopes dị iche iche?

A ga-ekpebi nhọrọ nke ụdị bronchoscope ụmụaka dabere na afọ onye ọrịa, oke ikuku, na nyocha na ọgwụgwọ echere. "Ntuziaka maka Bronchoscopy Ụmụaka na-agbanwe agbanwe na China (2018 Edition)" na ihe ndị yiri ya bụ ntụaka ndị bụ isi.

Ụdị bronchoscope bụ isi gụnyere bronchoscopes fiberoptic, bronchoscopes electronic, na bronchoscopes ngwakọta. Enwere ọtụtụ ụdị ụlọ ọhụrụ na ahịa, ọtụtụ n'ime ha dị oke mma. Ebumnobi anyị bụ imezu ahụ dị gịrịgịrị, ike ike buru ibu na onyonyo doro anya.

A na-ewebata ụfọdụ bronchoscopes na-agbanwe agbanwe:

Nhọrọ ụdị:

1. Bronchoscopes nwere dayameta nke 2.5-3.0mm:

Kwesịrị ekwesị maka ndị ọgbọ niile (gụnyere ụmụ ọhụrụ). Ugbu a dị na ahịa bụ bronchoscopes nwere dayameta mpụta nke 2.5mm, 2.8mm, na 3.0mm, yana ọwa ọrụ 1.2mm. Bronchoscopes ndị a nwere ike ịrụ agụụ, oxygenation, lavage, biopsy, brushing (mma bristle), laser dilatation, na balloon dilatation nke nwere akụkụ 1mm na-ebu ụzọ dilatation na stent metal.

2. Bronchoscopes nwere dayameta nke 3.5-4.0 mm:

N'echiche, nke a dị mma maka ụmụaka karịrị otu afọ. Ọwa 2.0 mm na-arụ ọrụ na-enye ohere maka usoro dị ka electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, na stent placement.

Olympus BF-MP290F bụ bronchoscope nwere dayameta mpụta nke 3.5 mm na ọwa 1.7 mm. NDỤMỌDỤ mpụta dayameta: 3.0 mm (akụkụ ntinye ≈ 3.5 mm); dayameta nke ọwa: 1.7 mm. Ọ na-enye ohere nke 1.5 mm biopsy forceps, 1.4 mm ultrasound probes, na 1.0 mm brushes. Mara na dayameta biopsy forceps 2.0 mm enweghị ike ịbanye ọwa a. Ụdị ụlọ dịka Shixin na-enyekwa nkọwapụta ndị yiri ya. Ọgbọ na-esote Fujifilm EB-530P na EB-530S usoro bronchoscopes na-egosipụta oke dị mkpa nke nwere dayameta mpụta nke 3.5 mm yana ọwa dayameta 1.2 mm dị n'ime. Ha dị mma maka nyocha na ntinye aka nke ọnya nku ume na mpaghara ma ụmụaka na ndị okenye. Ha dakọtara na brushes cytology 1.0 mm, 1.1 mm biopsy forceps, na 1.2mm ahụ ike nke mba ọzọ.

3. Bronchoscopes nwere dayameta nke 4.9 mm ma ọ bụ karịa:

Kwesịrị ekwesị maka ụmụaka dị afọ 8 na karịa na-eru 35 kg ma ọ bụ karịa. Ọwa ọrụ 2.0 mm na-enye ohere maka usoro dị ka electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, na stent placement. Ụfọdụ bronchoscopes nwere ọwa na-arụ ọrụ karịa 2 mm, na-eme ka ọ dịkwuo mfe maka usoro ntinye aka.

Dayameta

4. Ọnọdụ Pụrụ Iche: Ultrathin bronchoscopes nwere dayameta dị n'èzí nke 2.0 mm ma ọ bụ 2.2 mm na enweghị ọwa ọrụ nwere ike iji nyochaa obere ikuku ikuku nke ụmụ ọhụrụ akabeghị aka ma ọ bụ zuru oke. Ha dịkwa mma maka nyocha nke ikuku n'ime ụmụaka na-eto eto nwere nnukwu ikuku stenosis.

Na nkenke, a ga-ahọrọ ihe nlereanya kwesịrị ekwesị dabere na afọ onye ọrịa, oke ikuku, na diagnostic na ọgwụgwọ chọrọ iji hụ na usoro na-aga nke ọma na nchekwa.

Ụfọdụ ihe ị ga-arịba ama mgbe ị na-ahọrọ enyo:

Ọ bụ ezie na 4.0mm mpụta bronchoscopes dị mma maka ụmụaka karịrị 1 afọ, na-arụ ọrụ n'ezie, 4.0mm mpụta bronchoscopes siri ike iru miri bronchial lumen nke ụmụaka dị afọ 1-2 afọ. Ya mere, maka ụmụaka na-erubeghị 1 afọ, 1-2 afọ, na-erughị 15kg, mkpa bronchoscopes 2.8mm ma ọ bụ 3.0mm mpụta dayameta na-ejikarị eme ihe na-arụ ọrụ.

Maka ụmụaka dị afọ 3-5 na ịdị arọ 15kg-20kg, ị nwere ike ịhọrọ enyo dị mkpa nke nwere dayameta mpụta nke 3.0mm ma ọ bụ enyo nwere dayameta mpụta nke 4.2mm. Ọ bụrụ na eserese na-egosi na enwere nnukwu ebe atelectasis na plọg sputum nwere ike igbochi, a na-atụ aro ka ị jiri enyo nwere dayameta mpụta nke 4.2mm mbụ, nke nwere mmasị siri ike ma nwee ike ịmịpụta ya. Mgbe e mesịrị, a pụrụ iji enyo dị mkpa 3.0mm mee ihe maka igwu mmiri na nyocha. Ọ bụrụ na a na-atụle PCD, PBB, wdg, na ụmụaka na-enwekarị nnukwu ihe nzuzo nke purulent, a na-atụ aro ka ịhọrọ enyo siri ike na dayameta dị n'èzí nke 4.2mm, nke dị mfe ịdọrọ. Tụkwasị na nke ahụ, a pụkwara iji enyo nwere dayameta dị n'èzí nke 3.5mm.

Maka ụmụaka dị afọ 5 ma ọ bụ karịa ma na-eru 20 n'arọ ma ọ bụ karịa, a na-ahọrọ bronchoscope dị elu 4.2 mm. Ọwa mmanye nke 2.0 mm na-eme ka a na-emegharị ihe na ịmị ara.

Otú ọ dị, a ga-ahọrọ bronchoscope nke dị gịrịgịrị 2.8/3.0 mm n'ọnọdụ ndị a:

① Anatomical airway stenosis:

• stenosis nke ikuku ikuku na-amụ nwa ma ọ bụ mgbe arụchara ọrụ, tracheobronchomalacia, ma ọ bụ mkpakọ mpụta. • Dayameta dị n'ime nke subglottic ma ọ bụ akụkụ bronchial kacha warara <5 mm.

② trauma ma ọ bụ edema ụzọ ikuku na nso nso a

• Post-intubation glottic/ subglottic edema, ọkụ endotracheal, ma ọ bụ inhalation mmerụ ahụ.

③ Oke stridor ma ọ bụ nsogbu iku ume

• Nnukwu laryngotracheobronchitis ma ọ bụ ọnọdụ asthmaticus siri ike na-achọ obere mgbakasị ahụ.

④ Ụzọ imi nwere oghere imi dị warara

• Nnukwu stenosis nke oghere imi ma ọ bụ turbinate dị ala n'oge ntinye imi, na-egbochi nkwụsị nke 4.2 mm endoscopy na-enweghị mmerụ ahụ.

⑤ Achọrọ ịbanye n'ime akụkụ (ọkwa 8 ma ọ bụ karịa) bronchus.
• N'ọnọdụ ụfọdụ nke oyi oyi Mycoplasma siri ike na atelectasis, ma ọ bụrụ na ọtụtụ bronchoscopic alveolar lavages na nnukwu oge ka na-emezigharị atelectasis, enwere ike ịchọ ezigbo endoscope iji gbanye miri emi n'ime bronchoscope dị anya iji chọpụta ma gwọọ obere sputum plọgụ. • N'ọnọdụ ndị a na-enyo enyo na mgbochi bronchial (BOB), ihe na-esote nke oyi oyi siri ike, a pụrụ iji ezigbo endoscope mee ihe nke ọma na-abanye n'ime ala na mpaghara akụkụ nke akụkụ akpa ume na-emetụta. • N'ihe gbasara atresia nke bronchial congenital, igwu mmiri miri emi na ezigbo endoscope dịkwa mkpa maka atresia bronchial miri emi. • Tụkwasị na nke ahụ, ụfọdụ ọnya dị n'akụkụ na-agbasapụ (dị ka ọbara ọgbụgba alveolar na-agbasa na nodules) chọrọ endoscope kacha mma.

⑥ Nrụrụ cervical ma ọ bụ maxillofacial concomitant

• Micromandibular ma ọ bụ ọrịa craniofacial (dị ka ọrịa Pierre-Robin) na-egbochi oghere oropharyngeal.

⑦ Oge usoro dị mkpirikpi, na-achọ naanị nyocha nyocha

• Naanị BAL, brushing, ma ọ bụ biopsy dị mfe ka achọrọ; ọ dịghị nnukwu ngwá ọrụ achọrọ, na endoscope dị mkpa nwere ike ibelata iwe.

⑧ Nleba anya mgbe arụchara ọrụ ahụ

• Bronchoscopy siri ike na nso nso a ma ọ bụ ịgbasa balloon iji belata trauma mucosal nke abụọ.

Na mpempe:

"Stenosis, edema, mkpụmkpụ nke ume, obere nares, mpụta miri emi, nrụrụ, obere oge nyocha, na mgbake mgbe emechara" - ọ bụrụ na nke ọ bụla n'ime ọnọdụ ndị a dị, gbanwee gaa na 2.8-3.0 mm endoscope dị mkpa.

4. Maka ụmụaka ndị dị afọ> 8 na ịdị arọ> 35 n'arọ, enwere ike ịhọrọ endoscope nwere dayameta mpụta nke 4.9 mm ma ọ bụ karịa. Otú ọ dị, maka bronchoscopy oge niile, endoscopes dị ntakịrị na-akpasu onye ọrịa iwe ma belata ihe ize ndụ nke nsogbu ọ gwụla ma achọrọ enyemaka pụrụ iche.

5. Fujifilm si ugbu a isi ụmụaka EBUS nlereanya bụ EB-530US. Isi nkọwa ya dị ka ndị a: dayameta dị n'èzí: 6.7 mm, ntinye tube n'èzí: 6.3 mm, ọwa na-arụ ọrụ: 2.0 mm, ogologo ọrụ: 610 mm, na ogologo oge: 880 mm. Afọ na ịdị arọ akwadoro: N'ihi dayameta dị anya nke 6.7 mm nke endoscope, a na-atụ aro ya maka ụmụaka gbara afọ 12 na karịa ma ọ bụ na-eru> 40 n'arọ.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 afọ, ≥40 n'arọ. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 afọ, ≥20 n'arọ; maka ụmụaka ndị na-eto eto, ọ dị mkpa ka ebelatakwuo nyocha na dayameta enyo.

Okwu mmalite nke bronchoscopy dị iche iche

A na-ekewa bronchoscopes dị ka usoro ha si dị na ụkpụrụ onyonyo n'ime ụdị ndị a:

Fiberoptic bronchoscopes

Bronchoscopes electronic

Bronchoscopes jikọtara ọnụ

Bronchoscopes autofluorescence

Ultrasound bronchoscopes

……

Fiberoptic bronchoscopy:

Bronchoscope elektrọnik:

Bronchoscope mejupụtara:

Bronchoscopes ndị ọzọ:

Ultrasound bronchoscopes (EBUS): Achọpụta nyocha nke ultrasound etinyere n'ihu njedebe nke eletrọnịkị endoscope ka amara dị ka "ụzọ ikuku B-ultrasound." Ọ nwere ike banye n'ime mgbidi ikuku wee jiri anya nke ọma na-ahụ anya nke ọma na ọnụ ọgụgụ lymph mediastinal, arịa ọbara, na etuto ahụ n'èzí trachea. Ọ dị mma karịsịa maka ịchịkọta ndị ọrịa cancer akpa ume. Site na ntinye nke ultrasound na-eduzi, enwere ike nweta ihe nlele lymph node mediastinal nke ọma iji chọpụta ma etuto ahụ agbanweela, nwere ike zere mmerụ ahụ nke thoracotomy ọdịnala. E kewara EBUS na "nnukwu EBUS" maka ịhụ ọnya n'akụkụ nnukwu ụgbọ elu yana "obere EBUS" (ya na nyocha dị n'akụkụ) maka ịhụ ọnya nku ume. "Ebus buru ibu" na-egosipụta n'ụzọ doro anya mmekọrịta dị n'etiti arịa ọbara, ọnụ ọgụgụ lymph, na ọnya na-ekpuchi oghere n'ime mediastinum n'èzí ikuku. Ọ na-enye ohere maka agịga transbronchial ozugbo n'ime ọnya ahụ n'okpuru nlekota oge, na-ezere mmebi nke nnukwu arịa gbara ya gburugburu na akụkụ obi obi, na-eme ka nchekwa na izi ezi. "Obere EBUS" nwere ahụ pere mpe, na-enye ya ohere iji anya nke ọma hụ ọnya ngụgụ akụkụ ebe bronchoscopes nkịtị enweghị ike iru. Mgbe ejiri n'ọbọ mmeghe, ọ na-enye ohere maka nlele ziri ezi karịa.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy na-ejikọta bronchoscopes elektrọnik omenala na autofluorescence cellular na teknụzụ ozi iji chọpụta ọnya na-eji ọdịiche dị n'etiti sel tumor na sel nkịtị. N'okpuru ebili mmiri dị iche iche nke ìhè, ọnya ndị na-ebute ọrịa kansa ma ọ bụ etuto nke mmalite oge na-ewepụta ìhè pụrụ iche nke dị iche na agba nke anụ ahụ nkịtị. Nke a na-enyere ndị dọkịta aka ịchọpụta obere ọnya ndị siri ike ịchọpụta na endoscopy nke oge ochie, si otú a na-emeziwanye ọnụọgụ mbụ nke ọrịa kansa akpa ume.

Bronchoscopes dị oke mkpa:Bronchoscopes dị obere bụ usoro endoscopic na-agbanwe agbanwe nke nwere dayameta pere mpe (na-adịkarị <3.0 mm). A na-eji ha eme ihe maka nyocha ziri ezi ma ọ bụ ọgwụgwọ mpaghara mpaghara akpa ume dị anya. Isi uru ha bụ na ha nwere ike iji anya nke uche hụ bronchi subsegmental n'okpuru ọkwa 7, na-eme ka nyocha zuru ezu nke ọnya dị nro. Ha nwere ike iru obere bronchi nke siri ike iru na bronchoscopes ọdịnala, na-eme ka ọnụọgụ nchọpụta nke mbụ na-ebelata ọnyá ịwa ahụ.Onye ọsụ ụzọ na-akpachapụ anya na "njegharị + robotik":na-enyocha "mpaghara a na-akọwaghị" nke ngụgụ.

Bronchoscopy nke ikuku elektromagnetic (ENB) dị ka iji GPS kwado bronchoscope. Na tupu ịwa ahụ, a na-ewughachi ụdị ngụgụ 3D site na iji nyocha CT. N'oge ịwa ahụ, teknụzụ n'ọkwa electromagnetic na-eduzi endoscope site na alaka ụlọ ọrụ bronchi dị mgbagwoju anya, na-elekwasị anya kpọmkwem obere nodules nku ume na-atụ naanị milimita ole na ole na dayameta (dị ka nodules-glass n'okpuru 5 mm) maka biopsy ma ọ bụ ablation.

Bronchoscopy na-enyere aka robot: A na-achịkwa endoscope site na ogwe aka rọbọt nke dọkịta na-arụ na njikwa, na-ewepụ mmetụta nke ịma jijiji aka na ịnweta ọkwa dị elu. Ọgwụgwụ nke endoscope nwere ike ịtụgharị ogo 360, na-enye ohere maka ịnyagharị na-agbanwe agbanwe site na okporo ụzọ bronchi. Ọ dabara nke ọma maka ịmegharị ya nke ọma n'oge ịwa ahụ ngụgụ dị mgbagwoju anya ma nweelarị mmetụta dị ukwuu n'ubi obere biopsy nodule nku ume na ablation.

Ụfọdụ bronchoscopes ụlọ: