Xov xwm - Yuav ua li cas xaiv daim iav rau menyuam yaus bronchoscopy?

Keeb kwm kev loj hlob ntawm bronchoscopy

Lub tswv yim dav ntawm bronchoscope yuav tsum muaj xws li txhav bronchoscope thiab saj zawg zog (flexible) bronchoscope.

Xyoo 1897

Nyob rau hauv 1897, German laryngologist Gustav Killian ua thawj zaug bronchoscopic phais nyob rau hauv keeb kwm - nws siv ib tug nruj hlau endoscope tshem tawm ib tug pob txha txawv teb chaws lub cev los ntawm tus neeg mob lub trachea.

Xyoo 1904

Chevalier Jackson hauv Tebchaws Meskas tsim thawj bronchoscope.

Xyoo 1962

Tus kws kho mob Japanese Shigeto Ikeda tau tsim thawj fiberoptic bronchoscope. Qhov no hloov tau, microscopic bronchoscope, ntsuas tsuas yog ob peb millimeters nyob rau hauv txoj kab uas hla, kis dluab los ntawm kaum tawm txhiab ntawm optical fibers, ua kom yooj yim nkag mus rau hauv segmental thiab txawm subsegmental bronchi. Qhov kev tawg no tau tso cai rau cov kws kho mob pom cov qauv sib sib zog nqus hauv lub ntsws thawj zaug, thiab cov neeg mob tuaj yeem zam qhov kev kuaj mob hauv zos tshuaj loog, tshem tawm qhov xav tau kev siv tshuaj loog. Lub advent ntawm fiberoptic bronchoscope hloov bronchoscopy los ntawm tus txheej txheem invasive mus rau ib tug minimally invasive ntsuam xyuas, ua kom yooj yim rau kev kuaj ntxov ntawm cov kab mob xws li mob ntsws cancer thiab tuberculosis.

Xyoo 1966

Thaum Lub Xya Hli 1966, Machida tau tsim lub ntiaj teb thawj qhov tseeb fiberoptic bronchoscope. Thaum Lub Yim Hli 1966, Olympus kuj tau tsim nws thawj fiberoptic bronchoscope. Tom qab ntawd, Pentax thiab Fuji hauv Nyij Pooj, thiab Hma hauv Tebchaws Yelemees, kuj tau tso lawv tus kheej bronchoscopes.

Fiberoptic bronchoscope:

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

Compound bronchoscope:

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

Keeb kwm ntawm pediatric bronchoscopy hauv Suav teb

Kev kho mob siv fiberoptic bronchoscopy hauv cov menyuam yaus hauv kuv lub tebchaws tau pib xyoo 1985, tau tsim los ntawm cov tsev kho mob menyuam yaus hauv Beijing, Guangzhou, Tianjin, Shanghai, thiab Dalian. Lub tuam tsev ntawm lub hauv paus no, hauv 1990 (tsim tsim nyob rau hauv 1991), xibfwb Liu Xicheng, nyob rau hauv kev taw qhia ntawm xibfwb Jiang Zaifang, tsim Tuam Tshoj tus thawj pediatric bronchoscopy chav tsev ntawm Beijing Children's Hospital koom nrog Capital Medical University, kos npe rau lub official tsim ntawm Tuam Tshoj tus me nyuam bronchoscopy technology system. Thawj qhov kev kuaj mob fiberoptic bronchoscopy hauv tus menyuam tau ua los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Ua pa ntawm Lub Tsev Kho Mob Menyuam Yaus koom nrog Zhejiang University Tsev Kawm Ntawv Tshuaj hauv xyoo 1999, ua rau nws yog ib lub tsev kawm ntawv thawj zaug hauv Suav teb txhawm rau ua raws li cov kev kuaj mob fiberoptic bronchoscopy thiab kev kho mob hauv menyuam yaus.

Txoj kab uas hla ntawm cov menyuam yaus ntawm cov hnub nyoog sib txawv

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

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 kev npaj kho mob thiab kev kho mob. "Cov Lus Qhia rau Pediatric Flexible Bronchoscopy in China (2018 Edition)" thiab cov ntaub ntawv muaj feem xyuam yog cov ntaub ntawv tseem ceeb.

Bronchoscope hom feem ntau suav nrog fiberoptic bronchoscopes, hluav taws xob bronchoscopes, thiab ua ke bronchoscopes. Muaj ntau yam tshiab domestic hom nyob rau hauv kev ua lag luam, ntau yam ntawm cov khoom zoo. Peb lub hom phiaj yog kom ua tiav lub cev nyias, lub zog loj dua, thiab cov duab meej dua.

Qee qhov hloov tau yooj yim bronchoscopes tau qhia:

Qauv Xaiv:

1. Bronchoscopes nrog lub cheeb ntawm 2.5-3.0mm:

Haum rau txhua pab pawg hnub nyoog (nrog rau cov menyuam yaus). Tam sim no muaj nyob rau hauv kev ua lag luam yog bronchoscopes nrog sab diameters ntawm 2.5mm, 2.8mm, thiab 3.0mm, thiab nrog ib tug 1.2mm ua hauj lwm channel. Cov bronchoscopes no tuaj yeem ua rau kev xav, oxygenation, lavage, biopsy, txhuam hniav (zoo-bristle), laser dilatation, thiab balloon dilatation nrog 1 hli txoj kab uas hla ua ntej dilatation seem thiab hlau stents.

2. Bronchoscopes nrog txoj kab uas hla ntawm 3.5-4.0 mm:

Raws li txoj cai, qhov no tsim nyog rau cov menyuam yaus hnub nyoog qis dua ib xyoos. Nws 2.0 hli ua haujlwm channel tso cai rau cov txheej txheem xws li electrocoagulation, cryoablation, transbronchial koob aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, thiab stent placement.

Olympus BF-MP290F yog bronchoscope nrog ib txoj kab uas hla ntawm 3.5 hli thiab 1.7 hli channel. Sab nraud txoj kab uas hla: 3.0 hli (sib tshooj ≈ 3.5 hli); channel puab txoj kab uas hla: 1.7 mm. Nws tso cai rau kev hla ntawm 1.5 hli biopsy forceps, 1.4 hli ultrasound probes, thiab 1.0 hli txhuam. Nco ntsoov tias 2.0 hli txoj kab uas hla biopsy forceps tsis tuaj yeem nkag mus rau cov channel no. Cov khoom lag luam hauv tsev zoo li Shixin kuj muaj cov lus qhia zoo sib xws. Fujifilm cov tiam tom ntej EB-530P thiab EB-530S series bronchoscopes feature ib qho ultra-thin Scope nrog ib txoj kab uas hla ntawm 3.5 hli thiab 1.2 hli puab txoj kab uas hla. Lawv tsim nyog rau kev ntsuam xyuas thiab kev cuam tshuam ntawm peripheral ntsws lesions nyob rau hauv ob qho tib si 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. Bronchoscopes nrog txoj kab uas hla ntawm 4.9 mm los yog ntau dua:

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

Txoj kab uas hla

4. Cov Kabmob Tshwj Xeeb: Ultrathin bronchoscopes nrog ib txoj kab uas hla ntawm 2.0 mm lossis 2.2 mm thiab tsis muaj txoj haujlwm ua haujlwm tuaj yeem siv los tshuaj xyuas cov hlab ntsws me me ntawm cov menyuam mos ntxov ntxov lossis puv sijhawm. Lawv kuj tsim nyog rau kev ntsuam xyuas txoj hlab ntsws hauv cov menyuam mos uas muaj mob ntsws loj heev.

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

Qee yam yuav tsum nco ntsoov thaum xaiv daim iav:

Txawm hais tias 4.0mm sab nraud txoj kab uas hla bronchoscopes yog tsim rau cov menyuam yaus hnub nyoog qis dua 1 xyoos, hauv kev ua haujlwm tiag tiag, 4.0mm txheej txoj kab uas hla bronchoscopes yog qhov nyuaj kom ncav cuag qhov tob bronchial lumen ntawm cov menyuam hnub nyoog 1-2 xyoos. Yog li ntawd, rau cov menyuam yaus hnub nyoog qis dua 1 xyoos, 1-2 xyoos, thiab hnyav dua 15kg, nyias 2.8mm lossis 3.0mm sab nraud txoj kab uas hla bronchoscopes 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 ib daim iav nyias nrog ib txoj kab uas hla ntawm 3.0mm los yog daim iav nrog ib txoj kab uas hla ntawm 4.2mm. Yog tias cov duab qhia tau hais tias muaj thaj tsam loj ntawm atelectasis thiab cov hnoos qeev ntsaws yuav raug thaiv, nws raug nquahu kom siv daim iav nrog ib txoj kab uas hla ntawm 4.2 hli ua ntej, uas muaj zog txaus nyiam thiab tuaj yeem nqus tau. Tom qab ntawd, daim iav 3.0mm nyias tuaj yeem siv rau kev sib sib zog nqus drilling thiab tshawb nrhiav. Yog tias PCD, PBB, thiab lwm yam raug txiav txim siab, thiab cov menyuam yaus tuaj yeem ua rau muaj qhov ntau ntawm cov purulent secretions, nws tseem pom zoo kom xaiv ib daim iav tuab nrog ib txoj kab uas hla ntawm 4.2 hli, uas yooj yim rau kev nyiam. Tsis tas li ntawd, ib daim iav nrog ib txoj kab uas hla ntawm 3.5mm tuaj yeem siv tau.

Rau cov menyuam yaus hnub nyoog 5 xyoos lossis tshaj saud thiab hnyav 20 kg lossis ntau dua, feem ntau xav tau 4.2 hli inch bronchoscope. Lub 2.0 hli forceps channel txhawb kev tswj thiab nqus.

Txawm li cas los xij, ib lub thinner 2.8 / 3.0 mm sab nraud txoj kab uas hla bronchoscope yuav tsum raug xaiv hauv cov xwm txheej hauv qab no:

① Anatomical airway stenosis:

• Congenital lossis postoperative airway stenosis, tracheobronchomalacia, los yog extrinsic compression stenosis. • Internal txoj kab uas hla ntawm lub subglottic los yog nqaim tshaj bronchial ntu <5 mm.

② Tsis ntev los no txoj hlab ntsws raug mob los yog edema

• Post-intubation glottic/subglottic edema, endotracheal burns, los yog inhalation raug mob.

③ Mob hnyav stridor lossis ua pa nyuaj

• Mob laryngotracheobronchitis lossis mob hawb pob uas yuav tsum tau ua kom khaus tsawg.

④ Txoj kev qhov ntswg nrog qhov ntswg nqaim

• Tseem ceeb stenosis ntawm lub qhov ntswg vestibule los yog inferior turbinate thaum lub qhov ntswg insertion, tiv thaiv txoj kev ntawm ib tug 4.2 hli endoscope yam tsis muaj kev raug mob.

⑤ Yuav tsum nkag mus rau hauv ib qho chaw (qib 8 lossis siab dua) bronchus.
• Qee qhov mob hnyav Mycoplasma pneumonia nrog atelectasis, yog tias ntau lub bronchoscopic alveolar lavages nyob rau theem mob tseem tsis tuaj yeem kho atelectasis, yuav tsum tau siv lub tshuab endoscope kom tob tob rau hauv qhov distal bronchoscope txhawm rau tshawb xyuas thiab kho cov hnoos qeev me me. • Nyob rau hauv qhov xav tias muaj mob bronchial obstruction (BOB), ib tug sequelae ntawm mob ntsws loj heev, ib tug zoo endoscope yuav raug siv los laum tob rau hauv cov subbranches thiab subbranches ntawm lub ntsws cuam tshuam. • Nyob rau hauv cov ntaub ntawv ntawm congenital bronchial atresia, tob tob nrog ib tug zoo endoscope yog tsim nyog rau tob bronchial atresia. • Tsis tas li ntawd, qee qhov mob ntawm qhov chaw sab nraud (xws li diffuse alveolar hemorrhage thiab peripheral nodules) yuav tsum muaj qhov zoo tshaj plaws endoscope.

⑥ Concomitant cervical los yog maxillofacial deformities

• Micromandibular lossis craniofacial syndromes (xws li Pierre-Robin syndrome) txwv qhov chaw oropharyngeal.

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

• Tsuas yog yuav tsum muaj BAL, txhuam hniav, lossis kev kuaj ntshav yooj yim; tsis tas yuav tsum muaj cov twj paj nruag loj, thiab ib qho endoscope nyias tuaj yeem txo qhov khaus.

⑧ Kev soj ntsuam tom qab kev phais

• Tsis ntev los no nruj bronchoscopy los yog balloon dilatation kom txo tau cov mucosal trauma theem nrab.

Hauv luv luv:

"Stenosis, edema, ua tsis taus pa, me me nares, tob periphery, deformity, luv luv kuaj lub sij hawm, thiab postoperative rov qab" - yog hais tias ib yam ntawm cov kev mob tshwm sim, hloov mus rau ib tug 2.8-3.0 hli nyias endoscope.

4. Rau cov menyuam yaus hnub nyoog> 8 xyoo thiab hnyav> 35 kg, tuaj yeem xaiv qhov endoscope nrog ib txoj kab uas hla ntawm 4.9 mm lossis loj dua. Txawm li cas los xij, rau niaj hnub bronchoscopy, thinner endoscopes tsis tshua khaus rau tus neeg mob thiab txo qhov kev pheej hmoo ntawm cov teeb meem tshwj tsis yog yuav tsum tau muaj kev cuam tshuam tshwj xeeb.

5. Fujifilm tus qauv EBUS cov menyuam yaus tam sim no yog EB-530US. Nws cov ntsiab lus tseem ceeb yog raws li nram no: distal sab nraud txoj kab uas hla: 6.7 hli, ntxig raj sab nraud txoj kab uas hla: 6.3 hli, ua hauj lwm channel: 2.0 hli, ua hauj lwm ntev: 610 hli, thiab tag nrho ntev: 880 hli. Pom zoo hnub nyoog thiab qhov hnyav: Vim yog 6.7 mm distal distal ntawm lub endoscope, nws raug pom zoo rau cov menyuam yaus hnub nyoog 12 xyoo thiab laus dua lossis hnyav> 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 xyoos, ≥40 kg. (2) Radial EBUS + Ultrathin Daim iav (BF-MP290F Series): ≥6 xyoo, ≥20 kg; rau cov menyuam yaus, qhov kev sojntsuam thiab daim iav diameters yuav tsum tau txo qis ntxiv.

Taw qhia rau ntau yam bronchoscopy

Bronchoscopes tau muab cais raws li lawv cov qauv thiab cov qauv duab kos rau hauv cov hauv qab no:

Fiberoptic bronchoscopes

Electronic bronchoscopes

Combined bronchoscopes

Autofluorescence bronchoscopes

Ultrasound bronchoscopes

……

Fiberoptic bronchoscopy:

Electronic bronchoscope:

Compound bronchoscope:

Lwm yam bronchoscopes:

Ultrasound bronchoscopes (EBUS): Ib qho ultrasound sojntsuam koom ua ke rau hauv pem hauv ntej kawg ntawm ib qho hluav taws xob endoscope yog hu ua "airway B-ultrasound." Nws tuaj yeem nkag mus rau phab ntsa ntawm txoj hlab pa thiab pom meej meej pom cov qog nqaij hlav hauv nruab nrab, cov hlab ntsha, thiab cov qog nqaij hlav sab nraum lub trachea. Nws yog tshwj xeeb tshaj yog haum rau staging cov neeg mob ntsws cancer. Los ntawm ultrasound-guided puncture, mediastinal lymph node kuaj yuav raug tau kom raug los txiav txim seb lub qog puas tau metastasized, muaj peev xwm zam kev raug mob ntawm ib txwm thoracotomy. EBUS tau muab faib ua "EBUS loj" rau kev soj ntsuam cov kab mob nyob ib ncig ntawm cov pa loj thiab "EBUS me" (nrog rau kev sojntsuam peripheral) rau kev soj ntsuam cov kab mob ntsws peripheral. Lub "EBUS loj" qhia meej meej txog kev sib raug zoo ntawm cov hlab ntsha, cov qog nqaij hlav, thiab qhov chaw ua haujlwm nyob rau hauv lub mediastinum sab nraum cov pa. Nws kuj tso cai rau transbronchial koob aspiration ncaj qha mus rau hauv qhov txhab nyob rau hauv lub sij hawm saib xyuas, zoo zam kev puas tsuaj rau ib puag ncig cov hlab ntsha loj thiab cov kab mob plawv, txhim kho kev nyab xeeb thiab raug. "Me EBUS" muaj lub cev me me, tso cai rau nws kom pom tseeb pom cov kab mob hauv nruab nrog cev uas cov pa bronchoscopes tsis tuaj yeem ncav cuag. Thaum siv nrog ib qho kev nthuav qhia sheath, nws tso cai rau kev ua piv txwv ntau dua.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy sib txuas cov pa hluav taws xob bronchoscopes nrog cellular autofluorescence thiab cov ntaub ntawv thev naus laus zis los txheeb xyuas cov kab mob uas siv cov fluorescence sib txawv ntawm cov qog hlwb thiab cov hlwb ib txwm muaj. Nyob rau hauv ib lub wavelengths ntawm lub teeb, cov kab mob precancerous los yog cov qog nqaij hlav thaum ntxov emit ib tug tshwj xeeb fluorescence uas txawv ntawm cov xim ntawm cov ntaub so ntswg. Qhov no pab cov kws kho mob tshawb pom cov kab mob me me uas nyuaj rau kev kuaj pom nrog cov qauv endoscopy, yog li txhim kho qhov kev kuaj mob ntxov ntawm lub ntsws cancer.

Ultra-nyias bronchoscopes:Ultra-thin bronchoscopes yog cov txheej txheem endoscopic hloov tau yooj yim dua nrog lub taub me me (feem ntau <3.0 mm). Lawv feem ntau yog siv rau kev kuaj xyuas meej lossis kev kho mob ntawm lub ntsws hauv cheeb tsam. Lawv qhov txiaj ntsig tseem ceeb yog nyob rau hauv lawv lub peev xwm los pom cov bronchi subsegmental hauv qab qib 7, ua kom muaj kev soj ntsuam ntxaws ntxiv ntawm cov kab mob me me. Lawv tuaj yeem ncav cuag me me bronchi uas nyuaj rau ncav cuag nrog ib txwm siv bronchoscopes, txhim kho qhov kev kuaj pom ntawm qhov mob thaum ntxov thiab txo cov kev phais mob.Ib tug txiav-ntug pioneer hauv "navigation + robotics":tshawb txog qhov "uncharted territory" ntawm lub ntsws.

Electromagnetic navigation bronchoscopy (ENB) zoo li muab lub bronchoscope nrog GPS. Ua ntej ua haujlwm, 3D lub ntsws qauv yog rov tsim dua siv CT scans. Thaum lub sij hawm kev phais, electromagnetic positioning technology coj lub endoscope los ntawm complex bronchial ceg, precisely tsom me me peripheral ntsws nodules ntsuas tsuas yog ob peb millimeters inch (xws li av-iav nodules nyob rau hauv 5 hli) rau biopsy los yog ablation.

Robot-assisted bronchoscopy: Lub endoscope yog tswj los ntawm tus neeg hlau caj npab ua haujlwm los ntawm tus kws kho mob ntawm lub console, tshem tawm cov kev cuam tshuam ntawm tes tshee thiab ua tiav qhov tseeb ntawm qhov chaw siab dua. Qhov kawg ntawm qhov endoscope tuaj yeem tig 360 degrees, tso cai rau kev hloov pauv yooj yim los ntawm txoj hauv kev tortuous bronchial. Nws yog qhov tshwj xeeb zoo rau kev tswj xyuas meej thaum lub sijhawm phais mob ntsws thiab twb ua rau muaj kev cuam tshuam tseem ceeb hauv thaj chaw me me ntawm lub ntsws nodule biopsy thiab ablation.

Qee qhov bronchoscopes hauv tsev: