Xov Xwm - Yuav ua li cas xaiv daim iav rau kev kuaj mob bronchoscopy rau menyuam yaus?

Kev loj hlob keeb kwm ntawm bronchoscopy

Lub tswv yim dav dav ntawm bronchoscope yuav tsum suav nrog lub bronchoscope nruj thiab lub bronchoscope yoog tau (yooj yim).

1897 xyoo

Xyoo 1897, tus kws kho mob German laryngologist Gustav Killian tau ua thawj qhov kev phais mob bronchoscopic hauv keeb kwm - nws siv lub endoscope hlau khov kho kom tshem tawm cov pob txha txawv teb chaws ntawm tus neeg mob lub trachea.

1904 xyoo

Chevalier Jackson hauv Tebchaws Meskas tsim thawj lub bronchoscope.

1962 xyoo

Tus kws kho mob Nyiv Pooj Shigeto Ikeda tau tsim thawj lub tshuab fiberoptic bronchoscope. Lub tshuab bronchoscope no uas yooj ywm thiab me me, ntsuas tsuas yog ob peb millimeters hauv txoj kab uas hla, xa cov duab los ntawm ntau txhiab lub fiber optical, ua rau yooj yim ntxig rau hauv lub bronchi segmental thiab txawm tias subsegmental bronchi. Qhov kev tshawb pom no ua rau cov kws kho mob pom cov qauv tob hauv lub ntsws thawj zaug, thiab cov neeg mob tuaj yeem ua qhov kev kuaj mob hauv qab tshuaj loog hauv zos, tshem tawm qhov xav tau kev siv tshuaj loog dav dav. Kev tshwm sim ntawm lub tshuab fiberoptic bronchoscope tau hloov pauv bronchoscopy los ntawm kev phais mob mus rau kev kuaj mob tsawg kawg nkaus, ua rau yooj yim rau kev kuaj mob thaum ntxov xws li mob qog noj ntshav hauv lub ntsws thiab tuberculosis.

Xyoo 1966

Thaum Lub Xya Hli 1966, Machida tau tsim lub tshuab fiberoptic bronchoscope thawj zaug hauv ntiaj teb. Thaum Lub Yim Hli 1966, Olympus kuj tau tsim nws thawj lub tshuab fiberoptic bronchoscope. Tom qab ntawd, Pentax thiab Fuji hauv Nyiv Pooj, thiab Wolf hauv lub teb chaws Yelemees, kuj tau tso tawm lawv cov bronchoscopes.

Fiberoptic bronchoscope:

Olympus XP60, sab nraud txoj kab uas hla 2.8 hli, biopsy channel 1.2 hli

Cov khoom siv bronchoscope sib xyaw:

Olympus XP260, sab nraud txoj kab uas hla 2.8 hli, biopsy channel 1.2 hli

Keeb kwm ntawm kev kuaj mob bronchoscopy rau menyuam yaus hauv Suav teb

Kev siv tshuaj fiberoptic bronchoscopy rau cov menyuam yaus hauv kuv lub tebchaws tau pib xyoo 1985, ua ntej los ntawm cov tsev kho mob menyuam yaus hauv Beijing, Guangzhou, Tianjin, Shanghai, thiab Dalian. Tsim los ntawm lub hauv paus no, xyoo 1990 (tsim tsa xyoo 1991), Xibfwb Liu Xicheng, nyob rau hauv kev coj ntawm Xibfwb Jiang Zaifang, tau tsim thawj chav kuaj mob menyuam yaus hauv Tuam Tshoj ntawm Beijing Children's Hospital koom tes nrog Capital Medical University, cim qhov kev tsim tsa ntawm Tuam Tshoj txoj kev siv tshuab bronchoscopy menyuam yaus. Kev kuaj mob fiberoptic bronchoscopy thawj zaug hauv ib tug menyuam tau ua los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Ua Pa ntawm Tsev Kho Mob Menyuam yaus koom tes nrog Zhejiang University School of Medicine xyoo 1999, ua rau nws yog ib lub tsev kawm ntawv thawj zaug hauv Tuam Tshoj los siv kev kuaj mob fiberoptic bronchoscopy thiab kev kho mob hauv kev kho mob menyuam yaus.

Lub tracheal diameter ntawm cov menyuam yaus ntawm ntau lub hnub nyoog sib txawv

Yuav ua li cas xaiv cov qauv sib txawv ntawm bronchoscopes?

Qhov kev xaiv ntawm tus qauv bronchoscope rau menyuam yaus yuav tsum tau txiav txim siab raws li tus neeg mob lub hnub nyoog, qhov loj ntawm txoj hlab pa, thiab qhov kev kuaj mob thiab kev kho mob uas xav tau. Cov "Cov Lus Qhia rau Kev Siv Bronchoscopy Rau Menyuam Yaus hauv Suav Teb (2018 Tsab)" thiab cov ntaub ntawv cuam tshuam yog cov ntaub ntawv tseem ceeb.

Cov hom bronchoscope feem ntau suav nrog fiberoptic bronchoscopes, electronic bronchoscopes, thiab combining bronchoscopes. Muaj ntau hom tshiab hauv tebchaws hauv khw, ntau hom yog cov zoo. Peb lub hom phiaj yog ua kom lub cev nyias dua, cov forceps loj dua, thiab cov duab meej dua.

Qee cov bronchoscopes uas yoog tau tau qhia tawm:

Kev Xaiv Qauv:

1. Cov Bronchoscopes uas muaj txoj kab uas hla 2.5-3.0 hli:

Haum rau txhua lub hnub nyoog (xws li cov menyuam mos). Tam sim no muaj nyob rau hauv kev ua lag luam yog bronchoscopes nrog sab nraud txoj kab uas hla ntawm 2.5mm, 2.8mm, thiab 3.0mm, thiab nrog 1.2mm ua haujlwm channel. Cov bronchoscopes no tuaj yeem ua aspiration, oxygenation, lavage, biopsy, txhuam (fine-bristle), laser dilatation, thiab balloon dilatation nrog 1mm txoj kab uas hla pre-dilatation seem thiab hlau stents.

2. Cov Bronchoscopes nrog lub cheeb ntawm 3.5-4.0 hli:

Hauv kev xav, qhov no haum rau cov menyuam yaus hnub nyoog tshaj ib xyoos. Nws txoj kab ua haujlwm 2.0 hli tso cai rau cov txheej txheem xws li electrocoagulation, cryoablation, transbronchial koob aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, thiab stent placement.

Lub Olympus BF-MP290F yog lub bronchoscope nrog lub txoj kab uas hla sab nraud ntawm 3.5 hli thiab ib txoj kab uas hla 1.7 hli. Lub hau sab nraud ntawm lub qhov: 3.0 hli (qhov ntxig ≈ 3.5 hli); txoj kab uas hla sab hauv ntawm lub qhov: 1.7 hli. Nws tso cai rau 1.5 hli biopsy forceps, 1.4 hli ultrasound probes, thiab 1.0 hli txhuam hla. Nco ntsoov tias 2.0 hli txoj kab uas hla biopsy forceps tsis tuaj yeem nkag mus rau hauv txoj kab no. Cov hom lag luam hauv tebchaws xws li Shixin kuj muaj cov lus qhia zoo sib xws. Fujifilm lub cim tshiab EB-530P thiab EB-530S series bronchoscopes muaj lub scope nyias heev nrog lub txoj kab uas hla sab nraud ntawm 3.5 hli thiab ib txoj kab uas hla sab hauv ntawm 1.2 hli. Lawv tsim nyog rau kev kuaj xyuas thiab kev cuam tshuam ntawm cov kab mob ntsws peripheral hauv ob qho chaw menyuam yaus thiab cov neeg laus. Lawv sib xws nrog 1.0 hli cytology txhuam, 1.1 hli biopsy forceps, thiab 1.2 hli txawv teb chaws lub cev forceps.

3. Cov Bronchoscopes uas muaj txoj kab uas hla ntawm 4.9 mm lossis loj dua:

Feem ntau haum rau cov menyuam yaus hnub nyoog 8 xyoo thiab laus dua uas hnyav 35 kg lossis ntau dua. Lub channel ua haujlwm 2.0 hli tso cai rau cov txheej txheem xws li electrocoagulation, cryoablation, transbronchial koob aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, thiab stent placement. Qee lub bronchoscopes muaj lub channel ua haujlwm loj dua 2 hli, ua rau lawv yooj yim dua rau cov txheej txheem interventional.

Txoj kab uas hla

4. Cov Xwm Txheej Tshwj Xeeb: Cov khoom siv kuaj mob ntsws uas nyias heev uas muaj txoj kab uas hla sab nraud ntawm 2.0 hli lossis 2.2 hli thiab tsis muaj txoj kab ua haujlwm siv tau los kuaj xyuas cov hlab cua me me ntawm cov menyuam mos uas yug tsis tau hli lossis puv sijhawm. Lawv kuj tsim nyog rau kev kuaj xyuas cov hlab cua rau cov menyuam mos uas muaj kev mob hlab cua loj heev.

Hauv ntej, yuav tsum xaiv tus qauv tsim nyog raws li tus neeg mob lub hnub nyoog, qhov loj ntawm txoj hlab pa, thiab kev kuaj mob thiab kev kho mob kom ntseeg tau tias muaj kev ua tiav thiab muaj kev nyab xeeb.

Qee yam yuav tsum nco ntsoov thaum xaiv daim iav:

Txawm hais tias cov bronchoscopes uas muaj 4.0 hli sab nraud yog qhov tsim nyog rau cov menyuam yaus hnub nyoog tshaj 1 xyoos, thaum ua haujlwm tiag tiag, cov bronchoscopes uas muaj 4.0 hli sab nraud nyuaj rau ncav cuag cov lumen tob ntawm cov menyuam yaus hnub nyoog 1-2 xyoos. Yog li ntawd, rau cov menyuam yaus hnub nyoog qis dua 1 xyoos, 1-2 xyoos, thiab hnyav tsawg dua 15kg, cov bronchoscopes nyias nyias 2.8 hli lossis 3.0 hli sab nraud feem ntau yog siv rau kev ua haujlwm niaj hnub.

Rau cov menyuam yaus hnub nyoog 3-5 xyoos thiab hnyav 15kg-20kg, koj tuaj yeem xaiv daim iav nyias nyias uas muaj lub cheeb sab nraud ntawm 3.0mm lossis daim iav uas muaj lub cheeb sab nraud ntawm 4.2mm. Yog tias daim duab qhia tau tias muaj thaj chaw loj ntawm atelectasis thiab qhov ntsaws ntawm cov hnoos qeev yuav raug thaiv, nws raug pom zoo kom siv daim iav uas muaj lub cheeb sab nraud ntawm 4.2mm ua ntej, uas muaj zog rub thiab tuaj yeem nqus tawm. Tom qab ntawd, daim iav nyias nyias 3.0mm tuaj yeem siv rau kev khawb tob thiab kev tshawb nrhiav. Yog tias PCD, PBB, thiab lwm yam raug txiav txim siab, thiab cov menyuam yaus feem ntau yuav muaj ntau cov kua qaub ncaug, nws kuj raug pom zoo kom xaiv daim iav tuab uas muaj lub cheeb sab nraud ntawm 4.2mm, uas yooj yim rub. Tsis tas li ntawd, daim iav uas muaj lub cheeb sab nraud ntawm 3.5mm kuj tseem siv tau.

Rau cov menyuam yaus hnub nyoog 5 xyoos lossis laus dua thiab hnyav 20 kg lossis ntau dua, feem ntau zoo dua siv lub bronchoscope uas muaj txoj kab uas hla sab nraud 4.2 mm. Lub forceps 2.0 mm channel ua rau yooj yim rau kev tswj thiab kev nqus.

Txawm li cas los xij, yuav tsum xaiv lub bronchoscope nyias dua 2.8/3.0 mm sab nraud uas muaj txoj kab uas hla sab nraud:

① Kev mob ntawm txoj hlab pa hauv lub cev:

• Kab mob ua pa tsis zoo txij thaum yug los lossis tom qab phais, tracheobronchomalacia, lossis extrinsic compression stenosis. • Txoj kab uas hla sab hauv ntawm subglottic lossis qhov nqaim tshaj plaws ntawm bronchial segment < 5 mm.

② Kev raug mob los yog o ntawm txoj hlab pas tsis ntev los no

• Tom qab muab lub raj xa pa tso rau hauv lub qhov ntswg, o ntawm lub qhov ntswg/lub qhov ntswg sab hauv, kub hnyiab ntawm lub qhov ntswg, lossis raug mob thaum ua pa.

③ Ua pa nyuaj heev los yog ua pa nyuaj heev

• Mob ntsws laryngotracheobronchitis lossis mob ntsws asthma hnyav uas yuav tsum tau khaus me ntsis xwb.

④ Txoj kev qhov ntswg nrog qhov qhib qhov ntswg nqaim

• Lub qhov ntswg vestibule lossis lub qhov ntswg qis dua stenosis loj heev thaum ntxig rau hauv qhov ntswg, ua rau lub endoscope 4.2 mm tsis hla dhau yam tsis raug mob.

⑤ Yuav tsum tau nkag mus rau hauv lub ntsws peripheral (qib 8 lossis siab dua).
• Qee zaum ntawm Mycoplasma pneumonia hnyav nrog atelectasis, yog tias ntau zaus bronchoscopic alveolar lavages nyob rau theem mob hnyav tseem tsis tau rov qab kho atelectasis, yuav tsum tau siv lub endoscope zoo los khawb tob rau hauv distal bronchoscope los tshawb nrhiav thiab kho cov qhov me me, tob. • Hauv cov xwm txheej xav tias muaj bronchial obstruction (BOB), ib qho tshwm sim ntawm mob ntsws hnyav, yuav tsum tau siv lub endoscope zoo los khawb tob rau hauv subbranches thiab subsubbranches ntawm lub ntsws uas raug cuam tshuam. • Hauv cov xwm txheej ntawm bronchial atresia txij thaum yug los, kev khawb tob nrog lub endoscope zoo kuj tseem ceeb rau bronchial atresia tob. • Tsis tas li ntawd, qee qhov diffuse peripheral lesions (xws li diffuse alveolar hemorrhage thiab peripheral nodules) xav tau lub endoscope zoo dua.

⑥ Kev puas tsuaj ntawm lub caj dab lossis lub ntsej muag sab saud uas sib xws

• Cov kab mob Micromandibular lossis craniofacial (xws li Pierre-Robin syndrome) uas txwv qhov chaw oropharyngeal.

⑦ Lub sijhawm ua haujlwm luv luv, tsuas yog xav tau kev kuaj mob xwb

• Tsuas yog xav tau BAL, txhuam hniav, lossis kuaj nqaij xwb; tsis tas yuav siv cov cuab yeej loj, thiab lub endoscope nyias nyias tuaj yeem txo qhov khaus.

⑧ Kev soj ntsuam tom qab phais

• Tsis ntev los no tau kuaj lub ntsws los yog ua kom lub npuas loj dua kom txo tau qhov mob ntawm cov hlab ntsws.

Hauv luv luv:

"Pob ntseg nqaim, o, ua tsis taus pa, qhov ntswg me me, qhov tob ntawm qhov ntswg, qhov puas, lub sijhawm kuaj luv luv, thiab rov zoo tom qab phais" - yog tias muaj ib qho ntawm cov mob no, hloov mus rau lub endoscope nyias 2.8–3.0 hli.

4. Rau cov menyuam yaus hnub nyoog ntau tshaj 8 xyoo thiab hnyav ntau tshaj 35 kg, koj tuaj yeem xaiv lub endoscope uas muaj lub cheeb sab nraud ntawm 4.9 hli lossis loj dua. Txawm li cas los xij, rau kev kuaj mob bronchoscopy niaj hnub, cov endoscopes nyias dua yuav tsis ua rau tus neeg mob khaus thiab txo qhov kev pheej hmoo ntawm cov teeb meem tshwj tsis yog tias xav tau kev pab tshwj xeeb.

5. Fujifilm tus qauv EBUS rau menyuam yaus tam sim no yog EB-530US. Nws cov lus qhia tseem ceeb yog raws li nram no: qhov dav sab nraud ntawm lub qhov (distal absorption diameter): 6.7 mm, qhov dav sab nraud ntawm lub raj ntxig (insertion tube): 6.3 mm, txoj kab ua haujlwm: 2.0 mm, qhov ntev ua haujlwm: 610 mm, thiab tag nrho qhov ntev: 880 mm. Hnub nyoog thiab qhov hnyav pom zoo: Vim yog qhov dav sab nraud ntawm lub endoscope yog 6.7 mm, nws raug pom zoo rau cov menyuam yaus hnub nyoog 12 xyoos thiab laus dua lossis hnyav dua 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 xyoos, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 xyoos, ≥20 kg; rau cov menyuam yaus me, qhov ntsuas thiab daim iav yuav tsum tau txo kom tsawg dua.

Kev Taw Qhia Txog Ntau Yam Bronchoscopy

Cov bronchoscopes raug faib ua pawg raws li lawv cov qauv thiab cov ntsiab cai ntawm kev thaij duab rau hauv cov pawg hauv qab no:

Cov tshuab fiberoptic bronchoscopes

Cov tshuab kuaj mob ntsws hluav taws xob

Cov koob tshuaj bronchoscopes ua ke

Cov tshuab kuaj mob bronchoscopes uas siv lub teeb ci ntsa iab

Cov tshuab ultrasound bronchoscopes

……

Kev kuaj mob fiberoptic bronchoscopy:

Lub tshuab kuaj mob ntsws hluav taws xob:

Cov khoom siv bronchoscope sib xyaw:

Lwm cov bronchoscopes:

Cov Tshuab Ultrasound Bronchoscopes (EBUS): Ib qho ultrasound probe uas muab tso rau hauv qhov kawg ntawm lub tshuab hluav taws xob endoscope hu ua "airway B-ultrasound." Nws tuaj yeem nkag mus rau hauv phab ntsa ntawm txoj hlab pa thiab pom tseeb tias cov qog ntshav hauv lub ntsws, cov hlab ntsha, thiab cov qog nqaij hlav sab nraum lub trachea. Nws yog qhov tsim nyog rau kev txiav txim siab cov neeg mob qog noj ntshav hauv lub ntsws. Los ntawm kev siv ultrasound-guided puncture, cov qauv ntawm cov qog ntshav hauv lub ntsws tuaj yeem tau txais qhov tseeb los txiav txim siab seb cov qog nqaij hlav puas tau kis mus rau lwm qhov, tej zaum yuav zam kev raug mob ntawm kev phais mob hauv siab. EBUS muab faib ua "EBUS loj" rau kev soj ntsuam cov qhov txhab nyob ib puag ncig cov hlab ntsha loj thiab "EBUS me" (nrog peripheral probe) rau kev soj ntsuam cov qhov txhab hauv lub ntsws. "EBUS loj" qhia meej txog kev sib raug zoo ntawm cov hlab ntsha, cov qog ntshav, thiab cov qhov txhab uas nyob hauv mediastinum sab nraum cov hlab ntsha. Nws kuj tso cai rau kev siv koob txhaj tshuaj transbronchial ncaj qha mus rau hauv qhov txhab raws li kev saib xyuas tiag tiag, tiv thaiv kev puas tsuaj rau cov hlab ntsha loj thiab cov qauv plawv nyob ib puag ncig, txhim kho kev nyab xeeb thiab kev raug. Lub "EBUS me me" muaj lub cev me dua, ua rau nws pom tseeb cov qhov txhab ntawm lub ntsws uas cov bronchoscopes ib txwm tsis ncav cuag. Thaum siv nrog lub hnab introducer, nws ua rau kev kuaj mob meej dua.

Kev Siv Tshuaj Fluorescence Bronchoscopy: Kev siv tshuaj immunofluorescence bronchoscopy sib xyaw cov tshuab hluav taws xob bronchoscopes nrog rau kev siv cellular autofluorescence thiab thev naus laus zis los txheeb xyuas cov qhov txhab siv qhov sib txawv ntawm fluorescence ntawm cov hlwb qog thiab cov hlwb ib txwm muaj. Hauv qab cov nthwv dej tshwj xeeb ntawm lub teeb, cov qhov txhab ua ntej mob qog noj ntshav lossis cov qog nqaij hlav theem thaum ntxov tso tawm cov fluorescence tshwj xeeb uas txawv ntawm cov xim ntawm cov nqaij ib txwm muaj. Qhov no pab cov kws kho mob nrhiav pom cov qhov txhab me me uas nyuaj rau nrhiav pom nrog kev siv endoscopy ib txwm muaj, yog li txhim kho qhov kev kuaj mob thaum ntxov ntawm mob qog noj ntshav ntsws.

Cov koob tshuaj bronchoscopes nyias heev:Cov koob yees duab bronchoscopes uas nyias heev yog ib txoj kev siv endoscopic uas yooj ywm dua nrog lub cheeb me dua (feem ntau <3.0 hli). Lawv feem ntau yog siv rau kev kuaj xyuas lossis kho cov cheeb tsam ntawm lub ntsws distal. Lawv qhov zoo tshaj plaws yog lawv muaj peev xwm pom cov hlab ntsws hauv qab theem 7, ua rau kev kuaj xyuas cov qhov txhab me me kom ntxaws dua. Lawv tuaj yeem ncav cuag cov hlab ntsws me me uas nyuaj rau ncav cuag nrog cov koob yees duab bronchoscopes ib txwm muaj, txhim kho qhov nrawm ntawm kev kuaj pom cov qhov txhab thaum ntxov thiab txo qhov raug mob phais.Ib tug thawj coj tshiab hauv "kev taw qhia + robotics":tshawb nrhiav "thaj chaw tsis muaj daim duab" ntawm lub ntsws.

Kev siv tshuab electromagnetic navigation bronchoscopy (ENB) zoo li muab lub bronchoscope nrog GPS. Ua ntej phais, tus qauv ntsws 3D raug tsim kho dua tshiab siv CT scans. Thaum phais, thev naus laus zis electromagnetic positioning coj lub endoscope hla cov ceg bronchial nyuaj, tsom mus rau cov qog ntsws me me uas ntsuas tsuas yog ob peb millimeters hauv txoj kab uas hla (xws li cov qog iav hauv av qis dua 5 hli) rau kev kuaj mob lossis kev rho tawm.

Kev siv tshuab kuaj mob ntsws los ntawm neeg hlau: Lub tshuab kuaj mob endoscope raug tswj los ntawm caj npab neeg hlau uas tus kws kho mob ua haujlwm ntawm lub console, tshem tawm qhov cuam tshuam ntawm kev co tes thiab ua tiav qhov tseeb ntawm qhov chaw. Qhov kawg ntawm lub tshuab kuaj mob endoscope tuaj yeem tig 360 degrees, tso cai rau kev taw qhia yooj yim los ntawm txoj kev bronchial tortuous. Nws yog qhov tshwj xeeb tshaj yog zoo rau kev tswj hwm meej thaum lub sijhawm phais mob ntsws nyuaj thiab twb tau ua rau muaj kev cuam tshuam loj hauv cov teb ntawm cov qog me me ntawm lub ntsws biopsy thiab ablation.

Qee cov bronchoscopes hauv tsev: