Uphuhliso lwembali lwebronchoscopy
Ingcamango ebanzi ye-bronchoscope kufuneka ibandakanye i-bronchoscope eqinile kunye ne-flexible (flexible) bronchoscope.
1897
Ngomnyaka we-1897, i-laryngologist yaseJamani uGustav Killian wenza utyando lokuqala lwe-bronchoscopic kwimbali - wasebenzisa i-endoscope yentsimbi eqinile ukususa umzimba wangaphandle wamathambo kwi-trachea yesigulane.
1904
UChevalier Jackson eUnited States wenza ibronchoscope yokuqala.
1962
Ugqirha waseJapan uShigeto Ikeda wenze i-fiberoptic bronchoscope yokuqala. Le bronchoscope ibhetyebhetye, imicroscopic, inomlinganiselo nje weemilimitha ezimbalwa ububanzi, isasaze imifanekiso ngamashumi amawaka eentsinga zamehlo, nto leyo eyenza ukuba kube lula ukufakwa kwi-segmental kunye nakwi-bronchi engaphantsi. Le mpumelelo yavumela oogqirha ukuba babone izakhiwo ezinzulu kwimiphunga okokuqala, kwaye izigulane zikwazi ukunyamezela uviwo phantsi kwe-anesthesia yendawo, ukuphelisa imfuno ye-anesthesia jikelele. Ukufika kwe-fiberoptic bronchoscope kuguqule i-bronchoscopy ukusuka kwinkqubo ehlaselayo ukuya kuvavanyo olungephi, oluququzelela ukuxilongwa kwangoko kwezifo ezinjengomhlaza wemiphunga kunye nesifo sephepha.
1966
NgoJulayi 1966, uMachida wavelisa i-fiberoptic bronchoscope yokuqala yehlabathi. Ngo-Agasti 1966, i-Olympus nayo yavelisa i-fiberoptic bronchoscope yayo yokuqala. Emva koko, iPentax neFuji eJapan, neWolf yaseJamani, nazo zakhupha ezazo iibronchoscopes.
I-Fiberoptic bronchoscope:
I-Olympus XP60, i-diameter yangaphandle 2.8mm, i-biopsy channel 1.2mm
I-bronchoscope edibeneyo:
I-Olympus XP260, i-diameter yangaphandle 2.8mm, i-biopsy channel 1.2mm
Imbali ye-bronchoscopy yabantwana e-China
Ukusetyenziswa kweklinikhi ye-fiberoptic bronchoscopy kubantwana kwilizwe lam yaqala ngo-1985, iphayona kwizibhedlele zabantwana eBeijing, eGuangzhou, eTianjin, eShanghai naseDalian. Ukwakhiwa kwesi siseko, ngo-1990 (eyasungulwa ngokusemthethweni ngo-1991), uNjingalwazi uLiu Xicheng, phantsi kolwalathiso lukaNjingalwazi uJiang Zaifang, waseka igumbi lokuqala laseTshayina le-bronchoscopy yabantwana kwiSibhedlele saBantwana saseBeijing esidityaniswe neYunivesithi yezoNyango eyi-Capital Medical, ephawula ukusekwa ngokusemthethweni kwenkqubo yeteknoloji ye-bronchoscopy yabantwana yaseTshayina. Uviwo lokuqala lwe-fiberoptic bronchoscopy emntwaneni lwenziwa liSebe lokuphefumla kwiSibhedlele saBantwana esidibene neZhejiang University School of Medicine ngo-1999, okwenza libe lelinye lamaziko okuqala e-China ukuphumeza ngokucwangcisiweyo iimviwo ze-fiberoptic bronchoscopy kunye nonyango kwi-pediatrics.
Umthamo wetracheal wabantwana kwiminyaka eyahlukeneyo
Indlela yokukhetha iimodeli ezahlukeneyo ze-bronchoscopes?
Ukukhethwa kwemodeli yebronchoscope yabantwana kufuneka kumiselwe ngokusekelwe kwiminyaka yesigulane, ubungakanani bendlela yomoya, kunye nokuxilongwa kunye nonyango olujoliswe kuyo. "Izikhokelo ze-Pediatric Flexible Bronchoscopy e-China (uHlelo lwe-2018)" kunye nezixhobo ezihambelanayo zizinto eziphambili zokubhekisela.
Iindidi ze-bronchoscope ngokuyintloko ziquka i-fiberoptic bronchoscopes, i-bronchoscopes ye-elektroniki, kunye ne-bronchoscopes edibeneyo. Zininzi iimveliso zasekhaya ezintsha kwimarike, uninzi lwazo zikumgangatho ophezulu. Injongo yethu kukufezekisa umzimba omncinci, i-forceps enkulu, kunye nemifanekiso ecacileyo.
Ezinye iibronchoscopes eziguquguqukayo ziyaziswa:
Ukukhethwa koMfanekiso:
1. Iibronchoscopes ezinobubanzi obuyi-2.5-3.0mm:
Ilungele onke amaqela eminyaka ubudala (kubandakanywa nabasanda kuzalwa). Ikhoyo ngoku kwimarike iibronchoscopes ezinobubanzi obungaphandle obuyi-2.5mm, 2.8mm, kunye ne-3.0mm, kunye netshaneli esebenzayo eyi-1.2mm. Ezi bronchoscopes zingenza i-aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), i-laser dilatation, kunye ne-balloon dilatation kunye ne-1mm ye-diameter pre-dilatation section kunye ne-stents zetsimbi.
2. Iibronchoscopes ezinobubanzi obuyi-3.5-4.0 mm:
Ngokwethiyori, oku kufanelekile kubantwana abangaphezu konyaka omnye. Umjelo wayo osebenzayo we-2.0 mm uvumela iinkqubo ezifana ne-electrocoagulation, i-cryoablation, i-aspiration yenaliti ye-transbronchial (TBNA), i-transbronchial lung biopsy (TBLB), i-balloon dilatation, kunye nokubekwa kwe-stent.
I-Olympus BF-MP290F yi-bronchoscope ene-diameter yangaphandle ye-3.5 mm kunye ne-channel ye-1.7 mm. I-Tip ububanzi bangaphandle: 3.0 mm (inxalenye yokufaka ≈ 3.5 mm); umjelo ubukhulu yangaphakathi: 1.7 mm. Ivumela ukudlula kwe-1.5 mm ye-biopsy forceps, i-1.4 mm probes ye-ultrasound, kunye ne-1.0 mm yeebrashi. Qaphela ukuba i-2.0 mm i-diameter biopsy forceps ayikwazi ukungena kweli jelo. Iimveliso zasekhaya ezifana neShixin zikwabonelela ngeenkcukacha ezifanayo. Isizukulwana esilandelayo se-Fujifilm i-EB-530P kunye ne-EB-530S ye-bronchoscopes ebonisa i-ultra-thin scope kunye ne-diameter yangaphandle ye-3.5 mm kunye ne-1.2 mm yangaphakathi yeshaneli ye-diameter. Zifanelekele uviwo kunye nokungenelela kwezilonda zemiphunga ye-peripheral kwizicwangciso zabantwana kunye nabantu abadala. Ziyahambelana ne-1.0 mm ye-cytology brushes, i-1.1 mm ye-biopsy forceps, kunye ne-1.2 mm ye-forceps yomzimba wangaphandle.
3. Iibronchoscopes ezinobubanzi obuyi-4.9 mm okanye ngaphezulu:
Ngokuqhelekileyo ilungele abantwana abaneminyaka eyi-8 ubudala nangaphezulu ubunzima be-35 kg okanye ngaphezulu. Umzila osebenzayo we-2.0 mm uvumela iinkqubo ezifana ne-electrocoagulation, i-cryoablation, i-transbronchial needle aspiration (TBNA), i-transbronchial lung biopsy (TBLB), i-balloon dilatation, kunye nokubekwa kwe-stent. Ezinye i-bronchoscopes zinomjelo osebenzayo omkhulu kune-2 mm, okwenza kube lula ngakumbi kwiinkqubo zokungenelela.
Ububanzi
4. Iimeko Ezikhethekileyo: Iibronchoscopes ze-Ultrathin ezinobubanzi obungaphandle obuyi-2.0 mm okanye i-2.2 mm kwaye akukho mjelo wokusebenza onokusetyenziswa ukuhlola i-distal airways encinci yeentsana ezingaphambi kwexesha okanye ezipheleleyo. Zikwafanelekile kwiimviwo zomoya kwiintsana ezincinci ezine-stenosis yomoya.
Ngamafutshane, imodeli efanelekileyo kufuneka ikhethwe ngokusekelwe kwiminyaka yobudala besigulane, ubungakanani bendlela yomoya, kunye nokuxilongwa kunye neemfuno zonyango zokuqinisekisa inkqubo eyimpumelelo nekhuselekileyo.
Ezinye izinto ekufuneka uziqwalasele xa ukhetha isibuko:
Nangona i-bronchoscopes yedayamitha engaphandle eyi-4.0mm ifanelekile kubantwana abangaphezulu komnyaka omnye, ekusebenzeni kokwenyani, i-bronchoscopes yedayamitha yangaphandle eyi-4.0mm kunzima ukufikelela kwilumen enzulu yebronchi yabantwana abaneminyaka eyi-1-2 ubudala. Ngoko ke, kubantwana abangaphantsi komnyaka omnye, uku-1-2 ubudala, kunye nobunzima obungaphantsi kwe-15kg, ii-bronchoscopes ezibhityileyo eziyi-2.8mm okanye ezi-3.0mm zangaphandle zisetyenziswa ngokubanzi kwimisebenzi yesiqhelo.
Kubantwana abaneminyaka eyi-3-5 iminyaka kunye nobunzima be-15kg-20kg, unokukhetha isibuko esincinci esinobubanzi obungaphandle be-3.0mm okanye isibuko esinobubanzi obungaphandle be-4.2mm. Ukuba umfanekiso ubonisa ukuba kukho indawo enkulu ye-atelectasis kwaye iplagi yesikhohlela inokuvalwa, kuyacetyiswa ukuba kusetyenziswe isipili esinobubanzi obuyi-4.2mm kuqala, esinomtsalane owomeleleyo kwaye sinokufunxwa ngaphandle. Kamva, isipili esibhityileyo esiyi-3.0mm singasetyenziselwa ukugrumba okunzulu kunye nokuhlola. Ukuba i-PCD, i-PBB, njl. Ukongeza, isibuko esinobubanzi obungaphandle be-3.5mm sinokusetyenziswa.
Kubantwana abaneminyaka eyi-5 nangaphezulu kunye nobunzima be-20 kg nangaphezulu, i-bronchoscope yangaphandle ye-4.2 mm ikhethwa ngokubanzi. Itshaneli ye-forceps eyi-2.0 mm iququzelela ukukhohlisa kunye nokufunxa.
Nangona kunjalo, i-bronchoscope engaphantsi kwe-2.8 / 3.0 mm encinci kufuneka ikhethwe kwezi meko zilandelayo:
① I-Anatomical airway stenosis:
• I-Congenital or postoperative airway stenosis, tracheobronchomalacia, okanye i-extrinsic compression stenosis. • Idayamitha yangaphakathi ye-subglottic okanye i-bronchial segment emxinwa kakhulu <5 mm.
② Ukwenzakala kwamva nje kwendlela yomoya okanye i-edema
• I-post-intubation glottic/subglottic edema, ukutshisa kwe-endotracheal, okanye ukulimala kokuphefumla.
③ I-stridor eqatha okanye uxinzelelo lokuphefumla
• I-laryngotracheobronchitis ebukhali okanye imeko ebukhali ye-asthmaticus efuna ukucaphuka okuncinci.
④ Indlela yeempumlo enemingxuma emxinwa yeempumlo
• I-stenosis ebalulekileyo ye vestibule yeempumlo okanye i-turbinate engaphantsi ngexesha lokufakwa kweempumlo, ukuthintela ukudlula kwe-4.2 mm endoscope ngaphandle kokulimala.
⑤ Imfuneko yokungena kwi-peripheral (ibakala lesi-8 okanye ngaphezulu) ibronchus.
• Kwezinye iimeko ze-Mycoplasma pneumonia eyingozi kakhulu ene-atelectasis, ukuba iindawo ezininzi ze-alveolar lavages kwi-bronchoscopic kwinqanaba elibukhali zisasilela ukubuyisela i-atelectasis, i-endoscope ecocekileyo inokufuneka ukugrumba nzulu kwi-distal bronchoscope ukuze kuhlolwe kwaye kunyangwe iiplagi zesikhohlela ezincinci, ezinzulu. • Kwiimeko ekurhaneleka ukuba kukho isithintelo se-bronchial (BOB), ulandelelwano lwenyumoniya emandundu, i-endoscope ecolekileyo ingasetyenziselwa ukugrumba nzulu kumasetyana kunye namacandelwana ecandelo lemiphunga elichaphazelekayo. • Kwiimeko ze-congenital bronchial atresia, ukomba nzulu nge-endoscope ecolekileyo nako kuyafuneka kwi-bronchial atresia enzulu. • Ukongeza, ezinye izilonda ezisasazekileyo zombhobho (ezifana nokopha kwe-alveolar kunye neeqhuqhuva ezijikelezayo) zifuna i-endoscope ecolekileyo.
⑥ Ukukhubazeka okuhambelana nomlomo wesibeleko okanye ubukhulu be-maxillofacial
• I-Micromandibular okanye i-craniofacial syndromes (efana ne-Pierre-Robin syndrome) ethintela indawo ye-oropharyngeal.
⑦ Ixesha elifutshane lenkqubo, efuna kuphela uvavanyo lokuxilonga
• Kuphela i-BAL, ibrashi, okanye i-biopsy elula efunekayo; akukho zixhobo ezinkulu ezifunekayo, kwaye i-endoscope encinci inokunciphisa ukucaphuka.
⑧ Ukulandelela emva kokuhlinzwa
• I-bronchoscopy eqinileyo yakutsha nje okanye ukunwenwa kwebhaluni ukunciphisa umonzakalo wesibini we-mucosal.
Kufuphi:
"I-Stenosis, i-edema, ukuphefumula okufutshane, i-nares encinci, i-periphery enzulu, ukukhubazeka, ixesha elifutshane lokuvavanya, kunye nokubuyisela emva kokuhlinzwa" -ukuba kukho nayiphi na le meko, tshintshela kwi-endoscope encinci ye-2.8-3.0 mm.
4. Kubantwana abaneminyaka> iminyaka eyi-8 kunye nobunzima> 35 kg, i-endoscope enobubanzi obungaphandle be-4.9 mm okanye ngaphezulu ingakhethwa. Nangona kunjalo, kwi-bronchoscopy yesiqhelo, i-endoscopes encinci ayicaphukisi isigulane kwaye inciphisa umngcipheko weengxaki ngaphandle kokuba kufuneka ungenelelo olukhethekileyo.
5. Imodeli ye-EBUS yabantwana yangoku ye-Fujifilm yi-EB-530US. Iimpawu zayo eziphambili zilandelayo: i-distal yangaphandle ububanzi: 6.7 mm, i-tube yokufaka i-diameter yangaphandle: 6.3 mm, ishaneli esebenzayo: 2.0 mm, ubude bokusebenza: 610 mm, kunye nobude obupheleleyo: 880 mm. Ubudala obucetyiswayo kunye nobunzima: Ngenxa yobubanzi obuyi-6.7 mm ubude be-endoscope, kucetyiswa kubantwana abaneminyaka eyi-12 nangaphezulu okanye abanobunzima obungaphezulu kwama-40 kg.
I-Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 iminyaka ubudala, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 iminyaka ubudala, ≥20 kg; kubantwana abancinci, iprobe kunye neediameters zesipili kufuneka zincitshiswe ngakumbi.
Intshayelelo kwiibronchoscopy ezahlukeneyo
Iibronchoscopes zihlelwa ngokobume bazo kunye nemigaqo yokucinga ngokwezi ndidi zilandelayo:
Fiberoptic bronchoscopes
Iibronchoscopes ze-elektroniki
I-bronchoscopes edibeneyo
I-Autofluorescence bronchoscopes
Iibronchoscopes ze-ultrasound
……
I-Fiberoptic bronchoscopy:
Ibronchoscope yombane:
I-bronchoscope edibeneyo:
Ezinye iibronchoscopes:
I-Ultrasound bronchoscopes (EBUS): I-ultrasound probe ehlanganiswe kwi-front end ye-electronic endoscope eyaziwa ngokuba yi "airway B-ultrasound." Inokungena eludongeni lomoya kwaye ibone ngokucacileyo i-lymph nodes ye-mediastinal, imithwalo yegazi kunye ne-tumor ngaphandle kwe-trachea. Ilungele ngokukodwa izigulane zomhlaza wemiphunga. Ngokusebenzisa i-ultrasound-guided puncture, iisampulu ze-lymph node ze-mediastinal zingafunyanwa ngokuchanekileyo ukufumanisa ukuba i-tumor ine-metastasized, enokuthi ithintele ukwenzakala kwe-thoracotomy yendabuko. I-EBUS yohlulwe yaba "yi-EBUS enkulu" yokujonga izilonda ezijikeleze iindlela zomoya ezinkulu kunye "ne-EBUS encinci" (enombhobho ojikelezayo) yokujonga izilonda zombhobho wemiphunga. "I-EBUS enkulu" ibonisa ngokucacileyo ubudlelwane phakathi kwemithambo yegazi, i-lymph nodes, kunye nezilonda ezihlala kwindawo ngaphakathi kwe-mediastinum ngaphandle kweendlela zomoya. Kwakhona kuvumela i-aspiration yenaliti ye-transbronchial ngqo kwi-lesion phantsi kweliso lexesha langempela, ukuphepha ngokufanelekileyo umonakalo kwiinqanawa ezinkulu ezijikelezayo kunye nezakhiwo zentliziyo, ukuphucula ukhuseleko kunye nokuchaneka. "I-EBUS encinci" inomzimba omncinci, eyivumela ukuba ibone ngokucacileyo izilonda zemiphunga ye-peripheral apho ii-bronchoscopes eziqhelekileyo zingenako ukufikelela khona. Xa isetyenziswa kunye ne-introducer sheath, ivumela isampuli ezichanekileyo ngakumbi.
I-bronchoscopy ye-Fluorescence: I-Immunofluorescence bronchoscopy idibanisa i-bronchoscopes ye-elektroniki eqhelekileyo kunye ne-autofluorescence yeselula kunye neteknoloji yolwazi ukuchonga izilonda kusetyenziswa umahluko we-fluorescence phakathi kweeseli zethumba kunye neeseli eziqhelekileyo. Ngaphantsi kwamaza okukhanya athile, izilonda ezingaphambi komhlaza okanye amathumba akwinqanaba lokuqala akhupha i-fluorescence ekhethekileyo eyahlukileyo kumbala wethishu eqhelekileyo. Oku kunceda oogqirha babone izilonda ezincinci ekunzima ukuzibona nge-endoscopy yesiqhelo, ngaloo ndlela kuphuculwe izinga lokuxilongwa kwangoko komhlaza wemiphunga.
Iibronchoscopes ezibhityileyo kakhulu:I-bronchoscopes ene-ultra-thin iyindlela eguquguqukayo ye-endoscopic kunye ne-diameter encinci (ngokuqhelekileyo <3.0 mm). Zisetyenziselwa ikakhulu uviwo oluchanekileyo okanye unyango lwemimandla ye-distal lung. Inzuzo yabo ephambili ixhomekeke ekukwazini ukubona i-bronchi ephantsi kwe-subsegmental ngezantsi kwenqanaba lesi-7, okwenza ukuba uvavanyo olucacileyo lwezilonda ezifihlakeleyo. Banokufikelela kwi-bronchi encinci ekunzima ukufikelela kuyo kunye ne-bronchoscopes yendabuko, ukuphucula izinga lokubona izilonda zakuqala kunye nokunciphisa ukwenzakala kotyando.Uvulindlela obalaseleyo "kwi-navigation + robotics":ukuphonononga "ummandla ongachazwanga" wemiphunga.
I-Electromagnetic navigation bronchoscopy (ENB) ifana nokuxhobisa i-bronchoscope ngeGPS. Ngaphambili, imodeli ye-3D yemiphunga yakhiwe ngokutsha kusetyenziswa izikena ze-CT. Ngexesha lotyando, itekhnoloji yokubeka i-electromagnetic ikhokela i-endoscope kumasebe antsonkothileyo e-bronchial, ijolise ngokuchanekileyo amaqhuqhuva amancinane emiphunga akwi-millimeters ezimbalwa ububanzi (njengamaqhuqhuva eglasi ephantsi kwe-5 mm) kwi-biopsy okanye i-ablation.
I-bronchoscopy yokuncedisa i-robot: I-endoscope ilawulwa yingalo yerobhothi eqhutywe ngugqirha kwi-console, isusa impembelelo yezandla kunye nokufezekisa ukuchaneka kwendawo ephezulu. Isiphelo se-endoscope sinokujikeleza iidigri ezingama-360, ukuvumela ukuhamba okuguquguqukayo ngeendlela ezibuhlungu ze-bronchial. Ilungele ngokukodwa ukuguqulwa okuchanekileyo ngexesha lotyando oluntsonkothileyo lwemiphunga kwaye sele yenze impembelelo ebalulekileyo kwimimandla yeqhuqhuva lemiphunga emincinci kunye nokukhupha isisu.
Ezinye iibronchoscopes zasekhaya:
Ukongeza, iibrendi ezininzi zasekhaya ezinjengeAohua kunye neHuaguang nazo zilungile.
Makhe sibone ukuba yintoni esinokunikela ngayo njengezinto ezisetyenziselwa i-bronchoscopy
Nantsi into yethu eshushu yokuthengisa ibronchoscopy ehambelana ne-endoscopic consumables.
I-Catheter yesitshizi esilahliweyo
Iibrashi zeCytology ezilahlayo
I-Biopsy Forceps elahlayo-1.8mm i-biopsy forcepsyebronchoscopy ephinda isetyenziswe
1.0mm i-biopsy forcepsyebronchoscopy elahlayo
Ixesha lokuposa: Sep-03-2025