Litaba - Joang ho khetha seipone bakeng sa bronchoscopy ea bana?

Tsoelo-pele ea histori ea bronchoscopy

Khopolo e pharaletseng ea bronchoscope e lokela ho kenyelletsa bronchoscope e thata le bronchoscope e feto-fetohang (e feto-fetohang).

1897

Ka 1897, setsebi sa laryngologist sa Jeremane Gustav Killian o ile a etsa opereishene ea pele ea bronchoscopic historing - o ile a sebelisa endoscope ea tšepe e thata ho tlosa 'mele osele oa masapo ho tloha trachea ea mokuli.

1904

Chevalier Jackson oa United States o etsa bronchoscope ea pele.

1962

Ngaka ea Japane Shigeto Ikeda o ile a hlahisa bronchoscope ea pele ea fiberoptic. Bronchoscope ena e tenyetsehang, e nyenyane haholo, e bophara ba limilimithara tse seng kae feela, e fetisa litšoantšo ka mashome a likete a li-optical fibers, e leng se nolofalletsang ho kenngoa habonolo ka har'a bronchi ea likarolo esita le karolo e ka tlaase. Katleho ena e ile ea lumella lingaka hore li shebe ka mahlo libōpeho tse ka hare ho matšoafo ka lekhetlo la pele, 'me bakuli ba khona ho mamella tlhahlobo tlas'a anesthesia ea sebakeng seo, ho felisa tlhoko ea anesthesia e akaretsang. Ho fihla ha fiberoptic bronchoscope ho ile ha fetola bronchoscopy ho tloha ho mokhoa o hlaselang ho ea ho tlhahlobo e fokolang, ho nolofatsa tlhahlobo ea pele ea mafu a kang kankere ea matšoafo le lefuba.

1966

Ka Phupu 1966, Machida e hlahisitse bronchoscope ea pele ea 'nete ea fiberoptic lefatšeng. Ka Phato 1966, Olympus e ile ea boela ea hlahisa bronchoscope ea eona ea pele ea fiberoptic. Ka mor’a moo, Pentax le Fuji tsa Japane, le Wolf ea Jeremane, le tsona li ile tsa lokolla li-bronchoscope tsa tsona.

Fiberoptic bronchoscope:

Olympus XP60, bophara ba ka ntle 2.8mm, mocha oa biopsy 1.2mm

Motsoako oa bronchoscope:

Olympus XP260, bophara ba ka ntle 2.8mm, mocha oa biopsy 1.2mm

Histori ea bronchoscopy ea bana Chaena

Tšebeliso ea bongaka ea li-fiberoptic bronchoscopy ho bana naheng ea heso e qalile ka 1985, e ile ea buloa ke lipetlele tsa bana Beijing, Guangzhou, Tianjin, Shanghai le Dalian. Ho theoa holim'a motheo ona, ka 1990 (e thehiloeng ka molao ka 1991), Moprofesa Liu Xicheng, tlas'a tataiso ea Moprofesa Jiang Zaifang, o ile a theha kamore ea pele ea bana ea bana ea Chaena ea Sepetlele sa Bana sa Beijing se amanang le Capital Medical University, ho tšoaea ho thehoa ka molao tsamaiso ea theknoloji ea bana ea China ea bronchoscopy. Tlhahlobo ea pele ea "fiberoptic bronchoscopy" ho ngoana e ile ea etsoa ke Lefapha la Phefumoloho Sepetleleng sa Bana se amanang le Zhejiang University School of Medicine ka 1999, e leng se ileng sa etsa hore e be e 'ngoe ea litsi tsa pele tsa Chaena ho kenya ts'ebetsong litlhahlobo le liphekolo tsa mafu a bana.

Tracheal bophara ba bana ba lilemo tse fapaneng

U ka khetha mefuta e fapaneng ea bronchoscope joang?

Khetho ea mofuta oa bronchoscope ea bana e lokela ho khethoa ho latela lilemo tsa mokuli, boholo ba tsela ea moea, le tlhahlobo e reretsoeng le kalafo. "Guidelines for Pediatric Flexible Bronchoscopy in China (Khatiso ea 2018)" le lisebelisoa tse amanang le tsona ke litšupiso tsa mantlha.

Mefuta ea bronchoscope haholo-holo e kenyelletsa li-bronchoscope tsa fiberoptic, li-bronchoscope tsa elektroniki, le li-bronchoscope tse kopaneng. Ho na le lihlahisoa tse ngata tse ncha tsa lapeng 'marakeng, tseo bongata ba tsona e leng tsa boleng bo holimo. Sepheo sa rona ke ho finyella 'mele o mosesaane, li-forceps tse kholoanyane, le litšoantšo tse hlakileng haholoanyane.

Li-bronchoscope tse ling tse feto-fetohang li hlahisoa:

Khetho ea Moetso:

1. Li-bronchoscope tse nang le bophara ba 2.5-3.0mm:

E loketse batho ba lilemo tsohle (ho kenyeletsoa le bana ba sa tsoa tsoaloa). Hajoale tse fumanehang 'marakeng ke li-bronchoscope tse nang le bophara ba ka ntle ba 2.5mm, 2.8mm, le 3.0mm, le mocha o sebetsang oa 1.2mm. Li-bronchoscope tsena li ka etsa aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), laser dilatation, le balloon dilatation ka karolo ea 1mm ea bophara ba pele ho ho atolosoa le li-stents tsa tšepe.

2. Li-bronchoscope tse nang le bophara ba 3.5-4.0 mm:

Ka khopolo, sena se loketse bana ba ka holimo ho selemo. Mocha oa eona o sebetsang oa 2.0 mm o lumella lits'ebetso tse kang electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, le stent placement.

Olympus BF-MP290F ke bronchoscope e bophara ba ka ntle ba 3.5 mm le kanale ea 1.7 mm. Keletso bophara ba ka ntle: 3.0 mm (karolo ea ho kenya ≈ 3.5 mm); kanale bophara ba ka hare: 1,7 limilimithara. E lumella ho feta 1.5 mm biopsy forceps, 1.4 mm ultrasound probes, le 1.0 mm borashe. Hlokomela hore matlapa a biopsy a bophara ba 2.0 mm a ke ke a kena mocha ona. Lihlahisoa tsa malapeng joalo ka Shixin le tsona li fana ka litlhaloso tse tšoanang. Moloko o latelang oa Fujifilm oa EB-530P le EB-530S letoto la li-bronchoscope li na le scope e tšesaane haholo ka bophara ba 3.5 mm le kanale ea bophara ba 1.2 mm ka hare. Li loketse tlhahlobo le ho kenella ha liso tsa pheriferale ea matšoafo maemong a bana le a batho ba baholo. Li lumellana le 1.0 mm cytology brushes, 1.1 mm biopsy forceps, le 1.2 mm matla a 'mele a tsoang linaheng lisele.

3. Li-bronchoscope tse bophara ba 4.9 mm kapa ho feta:

Ka kakaretso e loketse bana ba lilemo tse 8 le ho feta ba boima ba 35 kg kapa ho feta. Mocha o sebetsang oa 2.0 mm o lumella lits'ebetso tse kang electrocoagulation, cryoablation, transbronchial nale aspiration (TBNA), transbronchial lung biopsy (TBLB), dilatation ea balune, le ho behoa ha stent. Li-bronchoscopes tse ling li na le mocha o sebetsang o moholo ho feta 2 mm, e leng se etsang hore e be bonolo haholoanyane bakeng sa mekhoa ea ho kenella.

Diameter

4. Linyeoe Tse Khethehileng: Li-bronchoscope tsa Ultrathin tse bophara bo ka ntle ba 2.0 mm kapa 2.2 mm ’me ha ho mocha o sebetsang o ka sebelisoang ho hlahloba litselana tse nyenyane tsa moea tsa masea a hlahileng pele ho nako kapa a nako e tletseng. Li boetse li loketse litlhahlobo tsa moea ho masea a manyenyane a nang le stenosis e matla ea moea.

Ka bokhutšoanyane, mohlala o loketseng o lokela ho khethoa ho latela lilemo tsa mokuli, boholo ba tsela ea moea, le litlhoko tsa tlhahlobo le kalafo ho netefatsa ts'ebetso e atlehileng le e bolokehileng.

Lintho tse ling tseo u lokelang ho li ela hloko ha u khetha seipone:

Le hoja li-bronchoscopes tsa bophara ba 4.0mm ka ntle li loketse bana ba ka holimo ho lilemo tse 1, ts'ebetsong ea sebele, li-bronchoscopes tse ka ntle tsa 4.0mm li thata ho finyella lumen e tebileng ea bana ba lilemo tse 1-2. Ka hona, bakeng sa bana ba ka tlase ho selemo se le seng, lilemo tse 1-2, le boima bo ka tlase ho 15kg, hangata li-bronchoscopes tse tšesaane tsa 2.8mm kapa 3.0mm ka ntle li sebelisoa bakeng sa tšebetso e tloaelehileng.

Bakeng sa bana ba lilemo li 3-5 le boima ba 15kg-20kg, o ka khetha seipone se tšesaane se nang le bophara bo ka ntle ba 3.0mm kapa seipone se nang le bophara ba ka ntle ba 4.2mm. Haeba litšoantšo li bontša hore ho na le sebaka se seholo sa atelectasis le plug ea sputum e ka thibeloa, ho kgothaletswa ho sebelisa seipone se nang le bophara ba ka ntle ba 4.2mm pele, se nang le khoheli e matla le e ka huloang. Hamorao, seipone se tšesaane sa 3.0mm se ka sebelisoa bakeng sa ho cheka ho tebileng le ho hlahloba. Haeba ho nahanoa ka PCD, PBB, joalo-joalo, 'me bana ba atisa ho ba le liphiri tse ngata tsa purulent, ho boetse ho kgothaletswa ho khetha seipone se teteaneng se nang le bophara ba ka ntle ba 4.2mm, seo ho leng bonolo ho se hohela. Ho phaella moo, seipone se nang le bophara bo ka ntle ba 3.5mm se ka boela sa sebelisoa.

Bakeng sa bana ba lilemo tse 5 kapa ho feta le boima ba lik'hilograma tse 20 kapa ho feta, bronchoscope e ka ntle ea bophara ba 4.2 mm hangata e khethoa. Sekanale sa 2.0 mm forceps se thusa ho qhekella le ho hula.

Leha ho le joalo, bronchoscope e mosesaane ea bophara ba 2.8/3.0 mm e lokela ho khethoa maemong a latelang:

① Anatomical airway stenosis:

• Congenital or postoperative airway stenosis, tracheobronchomalacia, kapa extrinsic compression stenosis. • Bophara ba ka hare ba karolo ea subglottic kapa e tšesaane ka ho fetisisa ea bronchial <5 mm.

② Mathata a morao-rao a tsela ea moea kapa edema

• Post-intubation glottic/subglottic edema, endotracheal burns, kapa kotsi ea ho hema.

③ Ho hema ho matla kapa khatello ea maikutlo

• Acute laryngotracheobronchitis kapa boemo bo matla ba asthmaticus bo hlokang ho teneha ho fokolang.

④ Tsela ea nko e nang le masoba a manyane

• Bohloko ba stenosis ea nasal vestibule kapa turbinate e tlaase nakong ea ho kenngoa ha nko, ho thibela ho feta ha 4.2 mm endoscope ntle le kotsi.

⑤ Tlhokahalo ea ho kenella ka har'a peripheral (grade 8 kapa holimo) bronchus.
• Maemong a mang a mycoplasma pneumonia e matla e nang le atelectasis, haeba li-multiple bronchoscopic alveolar lavages li ntse li hlōleha ho tsosolosa atelectasis, ho ka hlokahala endoscope e ntle ho phunya ka botebo ka har'a distal bronchoscope ho hlahloba le ho phekola li-plug tse nyenyane tse tebileng tsa sekhohlela. • Maemong a belaelloang a bronchial obstruction (BOB), sequelae ea pneumonia e matla, endoscope e ntle e ka sebelisoa ho phunya ka botebo ka har'a makala le makaleng a karolo ea matšoafo a amehileng. • Maemong a congenital bronchial atresia, ho phunya ho tebileng ka endoscope e ntle ho boetse hoa hlokahala bakeng sa atresia e tebileng ea bronchial. • Ho feta moo, maqeba a mang a pharalletseng (joalo ka phallo ea mali ea alveolar le maqhutsu a peripheral) a hloka endoscope e ntle haholoanyane.

⑥ Ho holofala ha cervical kapa maxillofacial

• Micromandibular kapa craniofacial syndromes (joaloka Pierre-Robin syndrome) e thibelang sebaka sa oropharyngeal.

⑦ Nako e khutšoanyane ea ts'ebetso, e hlokang tlhahlobo ea tlhahlobo feela

• Ho hlokahala feela BAL, brushing, kapa biopsy e bonolo; ha ho na lisebelisoa tse kholo tse hlokahalang, 'me endoscope e tšesaane e ka fokotsa ho teneha.

⑧ Ts'ebetso ea kamora ho buuoa

• Morao tjena bronchoscopy e thata kapa ho atolosoa ha balune ho fokotsa ts'oaetso ea bobeli ea mucosal.

Ka bokhutšoane:

"Stenosis, edema, phefumoloho e khutšoanyane, li-nares tse nyenyane, li-periphery tse tebileng, ho holofala, nako e khutšoanyane ea tlhahlobo, le ho hlaphoheloa ka mor'a ho buuoa" -haeba ho na le leha e le efe ea maemo ana, fetela ho endoscope e tšesaane ea 2.8-3.0 mm.

4. Bakeng sa bana ba lilemo tse> 8 le boima ba> 35 kg, ho ka khethoa endoscope e bophara ba 4.9 mm kapa ho feta. Leha ho le joalo, bakeng sa bronchoscopy e tloaelehileng, li-endoscope tse tšesaane ha li halefise mokuli haholo 'me li fokotsa kotsi ea mathata ntle le haeba ho hlokahala ho kenella ka mokhoa o khethehileng.

5. Mofuta oa EBUS oa Fujifilm oa mantlha oa bana ke EB-530US. Litlhaloso tsa eona tsa bohlokoa ke tse latelang: bophara ba ka ntle ba distal: 6.7 mm, bophara ba tube ea ho kenya ka ntle: 6.3 mm, mocha o sebetsang: 2.0 mm, bolelele ba ho sebetsa: 610 mm, le bolelele bohle: 880 mm. Lilemo tse khothalelitsoeng le boima ba 'mele: Ka lebaka la bophara ba 6.7 mm distal ea endoscope, e khothalletsoa bana ba lilemo tse 12 ho ea holimo kapa ba boima ba> 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 lilemo, ≥40 lik'hilograma. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 lilemo, ≥20 kg; bakeng sa bana ba banyenyane, probe le li-diameter tsa seipone li hloka ho fokotsoa le ho feta.

Kenyelletso ea mefuta e fapaneng ea bronchoscopy

Li-bronchoscope li arotsoe ho latela sebopeho sa tsona le melao-motheo ea litšoantšo ka mekhahlelo e latelang:

Fiberoptic bronchoscopes

Li-bronchoscope tsa elektroniki

Li-bronchoscopes tse kopantsoeng

Autofluorescence bronchoscopes

Ultrasound ea bronchoscopes

……

Fiberoptic bronchoscopy:

Bronchoscope ea elektroniki:

Motsoako oa bronchoscope:

Li-bronchoscope tse ling:

Ultrasound bronchoscopes (EBUS): Sesebelisoa sa ultrasound se kentsoeng karolong e ka pele ea endoscope ea elektronike e tsejoa e le "airway B-ultrasound." E ka kenella leboteng la moea 'me ea bona ka ho hlaka li-lymph nodes tsa mediastinal, methapo ea mali le lihlahala ka ntle ho trachea. E loketse haholo-holo ho bakuli ba mofetše oa matšoafo. Ka ho phunya ka tataiso ea ultrasound, lisampole tsa lymph node tsa mediastinal li ka fumanoa ka nepo ho fumana hore na hlahala e na le metastasized, e leng monyetla oa ho qoba ts'oaetso ea thoracotomy ea setso. EBUS e arotsoe ka "EBUS e kholo" bakeng sa ho shebella liso tse potolohileng litsela tse kholo tsa moea le "EBUS e nyenyane" (e nang le "peripheral probe) bakeng sa ho shebella maqeba a peripheral matšoafo. "EBUS e kholo" e bontša ka ho hlaka kamano pakeng tsa methapo ea mali, lymph nodes, le liso tsa sebaka ka har'a mediastinum ka ntle ho litsela tsa moea. E boetse e lumella ho ba le takatso ea nale ea transbronchial ka ho toba ka leqeba tlas'a tlhokomelo ea nako ea sebele, ka katleho ho qoba tšenyo ea lijana tse kholo tse potolohileng le mehaho ea pelo, ho ntlafatsa polokeho le ho nepahala. "EBUS e nyane" e na le 'mele o monyane, o e lumellang ho bona ka ho hlaka mats'oafo a peripheral moo li-bronchoscopes tse tloaelehileng li ke keng tsa fihla. Ha e sebelisoa le sheath ea introducer, e lumella lisampole tse nepahetseng haholoanyane.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy e kopanya li-bronchoscopes tse tloaelehileng tsa elektroniki le cellular autofluorescence le theknoloji ea tlhaiso-leseling ho khetholla liso ka ho sebelisa phapang ea fluorescence lipakeng tsa lisele tsa hlahala le lisele tse tloaelehileng. Ka tlas'a maqhubu a khethehileng a khanya, maqeba a precancerous kapa lihlahala tse qalang li hlahisa fluorescence e ikhethang e fapaneng le 'mala oa lisele tse tloaelehileng. Sena se thusa lingaka ho lemoha maqeba a manyane ao ho leng thata ho a lemoha ka mokhoa o tloaelehileng oa endoscopy, ka hona ho ntlafatsa sekhahla sa tlhahlobo ea pele ea mofetše oa matšoafo.

Li-bronchoscopes tse tšesaane haholo:Li-bronchoscopes tse tšesaane haholo ke mokhoa o feto-fetohang oa endoscopic o nang le bophara bo bonyenyane (ka tloaelo <3.0 mm). Li sebelisoa haholo bakeng sa tlhahlobo e nepahetseng kapa kalafo ea libaka tsa distal matšoafo. Monyetla oa bona o ka sehloohong o ho bokhoni ba bona ba ho bona bronchi e ka tlase ho boemo ba 7, e leng ho nolofalletsang tlhahlobo e qaqileng ea liso tse poteletseng. Li ka fihla li-bronchi tse nyane tseo ho leng thata ho li fihlela ka li-bronchoscopes tsa setso, ho ntlafatsa sekhahla sa ho lemoha maqeba a pele le ho fokotsa ho sithabela ha ho buuoa.Pula-maliboho ea tsoetseng pele ho "navigation + robotics":ho lekola "sebaka se sa tjhabeng" sa matshwafo.

Electromagnetic navigation bronchoscopy (ENB) e tšoana le ho hlomella bronchoscope ka GPS. Pele ho ts'ebetso, mofuta oa 3D oa matšoafo o hahuoa bocha ka lisebelisoa tsa CT. Nakong ea opereishene, theknoloji ea boemo ba motlakase e tataisa endoscope ho pholletsa le makala a thata a bronchial, e tobile ka nepo maqhutsu a manyane a mats'oafo a bophara ba limilimithara tse 'maloa feela (joalo ka maqhutsu a khalase ea fatše a ka tlase ho 5 mm) bakeng sa biopsy kapa ablation.

Bronchoscopy e thusoang ke roboto: Endoscope e laoloa ke letsoho la robotiki le sebelisoang ke ngaka ho console, ho felisa tšusumetso ea ho thothomela ha letsoho le ho finyella ho nepahala ha boemo bo phahameng. Qetello ea endoscope e ka potoloha likhato tse 360, e lumella ho tsamaea habonolo ka litsela tse bohloko tsa bronchial. E loketse ka ho khetheha bakeng sa ho qhekella ka nepo nakong ea liopereishene tse rarahaneng tsa matšoafo 'me e se e bile le tšusumetso e kholo mafapheng a biopsy ea maqhutsu a manyane a matšoafo le ablation.

Li-bronchoscope tse ling tsa malapeng: