Uphuhliso lwembali lwe-bronchoscopy
Ingcamango ebanzi ye-bronchoscope ifanele ibandakanye i-bronchoscope eqinileyo kunye ne-bronchoscope eguquguqukayo (eguquguqukayo).
1897
Ngo-1897, ingcali ye-laryngologist yaseJamani uGustav Killian yenza utyando lokuqala lwe-bronchoscopic kwimbali - wasebenzisa i-endoscope yesinyithi eqinileyo ukususa umzimba wangaphandle onethambo kwi-trachea yesigulana.
1904
UChevalier Jackson eMelika wenza i-bronchoscope yokuqala.
1962
Ugqirha waseJapan uShigeto Ikeda wavelisa i-bronchoscope yokuqala ye-fiberoptic. Le bronchoscope eguquguqukayo, enomkroskopu, enobukhulu obuziimilimitha ezimbalwa kuphela, idlulisele imifanekiso kumawaka eefayibha ze-optical, nto leyo eyenza kube lula ukufaka kwi-bronchi eqhekezayo neyangaphantsi kwesegment. Olu phuculo luvumele oogqirha ukuba babone izakhiwo ezingaphakathi kwemiphunga okokuqala, kwaye izigulana zazinokunyamezela ukuvavanywa phantsi kwe-anesthesia yendawo, nto leyo eyasusa isidingo se-anesthesia ngokubanzi. Ukufika kwe-bronchoscope ye-fiberoptic kwaguqula i-bronchoscopy ukusuka kwinkqubo yokungenelela ukuya kuvavanyo olungenakungenelela kakhulu, nto leyo eyanceda ekufumaneni izifo ezinje ngomhlaza wemiphunga kunye nesifo sephepha kwangethuba.
1966
NgoJulayi 1966, uMachida wavelisa i-bronchoscope yokuqala ye-fiberoptic ehlabathini. Ngo-Agasti 1966, i-Olympus yavelisa i-bronchoscope yayo yokuqala ye-fiberoptic. Emva koko, i-Pentax kunye ne-Fuji eJapan, kunye ne-Wolf eJamani, nazo zakhupha ii-bronchoscope zazo.
I-bronchoscope ye-fiberoptic:
I-Olympus XP60, ububanzi obungaphandle obuyi-2.8mm, itshaneli ye-biopsy eyi-1.2mm
I-bronchoscope edibeneyo:
I-Olympus XP260, ububanzi obungaphandle obuyi-2.8mm, itshaneli ye-biopsy eyi-1.2mm
Imbali ye-bronchoscopy yabantwana eTshayina
Ukusetyenziswa kwe-fiberoptic bronchoscopy ebantwaneni kwilizwe lam kwaqala ngo-1985, kwaqalwa zizibhedlele zabantwana eBeijing, eGuangzhou, eTianjin, eShanghai, naseDalian. Esakha phezu kwesi siseko, ngo-1990 (esasekwa ngokusesikweni ngo-1991), uNjingalwazi uLiu Xicheng, phantsi kolawulo lukaNjingalwazi uJiang Zaifang, waseka igumbi lokuqala le-bronchoscopy yabantwana eTshayina kwiSibhedlele saBantwana saseBeijing elinxulumene neCapital Medical University, nto leyo eyaphawula ukusekwa ngokusesikweni kwenkqubo yeteknoloji ye-bronchoscopy yabantwana yaseTshayina. Uvavanyo lokuqala lwe-fiberoptic bronchoscopy emntwaneni lwenziwa liSebe lezokuPhefumla kwiSibhedlele saBantwana elinxulumene neZhejiang University School of Medicine ngo-1999, nto leyo eyenza ukuba libe lelinye lamaziko okuqala eTshayina ukuphumeza ngokucwangcisiweyo uvavanyo lwe-fiberoptic bronchoscopy kunye nonyango lwabantwana.
Ububanzi be-trachea yabantwana abakwiminyaka eyahlukeneyo
Ungakhetha njani iimodeli ezahlukeneyo ze-bronchoscopes?
Ukukhethwa kwemodeli ye-bronchoscope yabantwana kufuneka kumiselwe ngokusekelwe kubudala besigulana, ubungakanani bomoya, kunye nokuxilongwa kunye nonyango olucetywayo. "Izikhokelo ze-Pediatric Flexible Bronchoscopy eTshayina (uHlelo luka-2018)" kunye nezixhobo ezinxulumene noko zezona zikhokelo ziphambili.
Iintlobo zeBronchoscope ziquka ii-bronchoscope ze-fiberoptic, ii-bronchoscope ze-elektroniki, kunye nee-bronchoscopes ezidibeneyo. Kukho iintlobo ezininzi ezintsha zasekhaya ezithengiswayo, uninzi lwazo zikumgangatho ophezulu. Injongo yethu kukufumana umzimba omncinci, ii-forceps ezinkulu, kunye nemifanekiso ecacileyo.
Ezinye ii-bronchoscopes eziguquguqukayo ziyaziswa:
Ukhetho lweModeli:
1. Iibronchoscopes ezinobubanzi obuyi-2.5-3.0mm:
Zilungele bonke ubudala (kuquka nabantwana abancinci). Okwangoku zifumaneka kwimarike ii-bronchoscopes ezinobubanzi bangaphandle obuyi-2.5mm, 2.8mm, kunye ne-3.0mm, kwaye zinetshaneli yokusebenza eyi-1.2mm. Ezi bronchoscopes zinokwenza ukufunxa, i-oxygenation, i-lavage, i-biopsy, i-brushing (i-fine-bristle), i-laser dilatation, kunye ne-balloon dilatation ene-1mm diameter pre-dilatation section kunye ne-metal stents.
2. Iibronchoscopes ezinobubanzi obuyi-3.5-4.0 mm:
Ngokwethiyori, oku kufanelekile kubantwana abangaphezu konyaka omnye ubudala. Umjelo wayo osebenzayo oyi-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.
I-Olympus BF-MP290F yi-bronchoscope enobubanzi obungaphandle obuyi-3.5 mm kunye nomjelo oyi-1.7 mm. Ububanzi obungaphandle obuyi-tip: 3.0 mm (inxalenye yokufakwa ≈ 3.5 mm); ububanzi obungaphakathi komjelo: 1.7 mm. Ivumela ukudlula kwe-1.5 mm biopsy forceps, i-1.4 mm ultrasound probes, kunye neebhrashi eziyi-1.0 mm. Qaphela ukuba i-2.0 mm diameter biopsy forceps ayinakungena kule mjelo. Iimpawu zasekhaya ezifana neShixin nazo zibonelela ngeenkcukacha ezifanayo. I-Fujifilm's next-generation EB-530P kunye ne-EB-530S series bronchoscopes zine-ultra-thin scope enobubanzi obungaphandle obuyi-3.5 mm kunye nomjelo ongaphakathi obuyi-1.2 mm diameter. Zifanelekile ukuvavanywa kunye nokungenelela kwezilonda zemiphunga ezingaphandle kwiindawo zabantwana kunye nabantu abadala. Ziyahambelana neebhrashi ze-cytology eziyi-1.0 mm, i-1.1 mm biopsy forceps, kunye ne-1.2 mm foreign body forceps.
3. IiBronchoscopes ezinobubanzi obuyi-4.9 mm okanye ngaphezulu:
Ngokubanzi ifanelekile kubantwana abaneminyaka esi-8 nangaphezulu ubunzima obuyi-35 kg okanye ngaphezulu. Itshaneli yokusebenza eyi-2.0 mm ivumela iinkqubo ezifana ne-electrocoagulation, i-cryoablation, i-transbronchial needle aspiration (TBNA), i-transbronchial lung biopsy (TBLB), i-balloon dilatation, kunye nokubekwa kwe-stent. Ezinye ii-bronchoscopes zinetshaneli yokusebenza engaphezulu kwe-2 mm, nto leyo eyenza kube lula ngakumbi kwiinkqubo zokungenelela.
Ububanzi
4. Iimeko ezikhethekileyo: Ii-bronchoscopes ezincinci kakhulu ezinobubanzi obungaphandle obuyi-2.0 mm okanye i-2.2 mm kwaye akukho mjelo usebenzayo onokusetyenziselwa ukuhlola iindlela zomoya ezincinci ezikude zeentsana ezizelwe ngaphambi kwexesha okanye ezizeleyo. Zikwafanelekile nokuhlolwa kwendlela yomoya kwiintsana ezincinci ezine-stenosis enzima yomoya.
Ngamafutshane, imodeli efanelekileyo kufuneka ikhethwe ngokusekelwe kwiminyaka yesigulana, ubungakanani bomoya, kunye neemfuno zokuxilongwa kunye nonyango ukuqinisekisa inkqubo ephumelelayo nekhuselekileyo.
Ezinye izinto ekufuneka uziqaphele xa ukhetha isibuko:
Nangona ii-bronchoscopes ezinde ezizi-4.0mm zilungele abantwana abangaphezu konyaka omnye ubudala, xa zisebenza ngokwenene, ii-bronchoscopes ezinde ezizi-4.0mm kunzima ukufikelela kwi-lumen enzulu ye-bronchial yabantwana abaneminyaka eli-1-2 ubudala. Ke ngoko, kubantwana abangaphantsi konyaka omnye, abaneminyaka eli-1-2 ubudala, kwaye benobunzima obungaphantsi kwe-15kg, ii-bronchoscopes ezinde ezizi-2.8mm okanye ezizi-3.0mm ububanzi bangaphandle zihlala zisetyenziselwa imisebenzi yesiqhelo.
Kubantwana abaneminyaka emi-3 ukuya kwemi-5 ubudala kwaye banobunzima obuyi-15kg-20kg, ungakhetha isibuko esincinci esinobubanzi obungaphandle obuyi-3.0mm okanye isibuko esinobubanzi obungaphandle obuyi-4.2mm. Ukuba umfanekiso ubonisa ukuba kukho indawo enkulu ye-atelectasis kwaye iplagi ye-sputum inokuthi ivalwe, kucetyiswa ukuba kusetyenziswe isibuko esinobubanzi obungaphandle obuyi-4.2mm kuqala, esinomtsalane onamandla kwaye sinokutsalwa. Kamva, isibuko esincinci esiyi-3.0mm singasetyenziselwa ukubhola nzulu nokuhlola. Ukuba kucingelwa ukuba i-PCD, i-PBB, njl. njl., kwaye abantwana bathambekele kwinani elikhulu le-purulent secretions, kucetyiswa ukuba kukhethwe isibuko esityebileyo esinobubanzi obungaphandle obuyi-4.2mm, okulula ukusitsala. Ukongeza, isibuko esinobubanzi obungaphandle obuyi-3.5mm naso singasetyenziswa.
Kubantwana abaneminyaka emi-5 nangaphezulu kwaye banobunzima obuyi-20 kg nangaphezulu, i-bronchoscope yangaphandle enobubanzi obuyi-4.2 mm ikhethwa kakhulu. Itshaneli ye-forceps eyi-2.0 mm inceda ekulawuleni nasekufunxeni.
Nangona kunjalo, i-bronchoscope ebhityileyo engaphandle enobubanzi obuyi-2.8/3.0 mm kufuneka ikhethwe kwezi meko zilandelayo:
① I-anatomical airway stenosis:
• I-Congenital okanye emva kotyando i-airway stenosis, i-tracheobronchomalacia, okanye i-extrinsic compression stenosis. • Ububanzi bangaphakathi be-subglottic okanye i-bronchial segment encinci < 5 mm.
② Ukulimala okanye ukudumba komoya okutsha nje
• Ukudumba kwe-glottic/subglottic emva kokufakwa kwityhubhu, ukutsha kwe-endotracheal, okanye ukwenzakala ekuphefumleni.
③ Uxinzelelo olukhulu okanye ukuphefumla
• I-laryngotracheobronchitis ebukhali okanye i-asthmaticus enzulu edinga ukurhawuzelelwa okuncinci.
④ Indlela yokungena empumlweni enemingxunya emincinci yempumlo
• Ukubetheka okukhulu kwe-nasal vestibule okanye i-inferior turbinate ngexesha lokufakwa kwe-nasal, okuthintela ukudlula kwe-endoscope ye-4.2 mm ngaphandle kokwenzakala.
⑤ Imfuneko yokungena kwi-bronchus engaphakathi (yebanga lesi-8 nangaphezulu).
• Kwezinye iimeko zeMycoplasma pneumonia enzima ene-atelectasis, ukuba ii-lavages ezininzi ze-alveolar ze-bronchoscopic kwisigaba esibukhali azikwazi ukubuyisela i-atelectasis, i-endoscope encinci inokufuneka ukugqobhoza nzulu kwi-distal bronchoscope ukuze kuhlolwe kwaye kunyangwe ii-sputum plugs ezincinci nezinzulu. • Kwiimeko ezirhanelekayo zokuvaleka kwe-bronchial (BOB), okubangela i-pneumonia enzima, i-endoscope encinci ingasetyenziselwa ukugqobhoza nzulu kwii-subbranches nakwi-subbranches ze-lung segment echaphazelekayo. • Kwiimeko ze-congenital bronchial atresia, ukugqobhoza nzulu nge-endoscope encinci nako kuyimfuneko kwi-deep bronchial atresia. • Ukongeza, ezinye izilonda ze-peripheral diffuse (ezifana ne-diffuse alveolar hemorrhage kunye ne-peripheral nodules) zifuna i-endoscope encinci.
⑥ Ukukhubazeka komlomo wesibeleko okanye ubuso obuphezulu
• Ii-micromandibular okanye i-craniofacial syndromes (ezifana ne-Pierre-Robin syndrome) ezithintela indawo ye-oropharyngeal.
⑦ Ixesha elifutshane lenkqubo, elifuna uviwo lokuxilonga kuphela
• Kufuneka i-BAL, ibrashi, okanye i-simple biopsy kuphela; akukho zixhobo zinkulu zifunekayo, kwaye i-endoscope encinci inokunciphisa ukurhawuzelelwa.
⑧ Ukulandelela emva kotyando
• Ukwanda kwe-bronchoscopy okanye i-balloon dilatation yakutshanje ukunciphisa ukwenzakala kwe-mucosal yesibini.
Kufuphi:
"I-stenosis, ukudumba, ukuphefumla kancinci, ii-nares ezincinci, umngcipheko onzulu, ukukhubazeka, ixesha elifutshane lokuhlolwa, kunye nokuchacha emva kotyando"—ukuba kukho naziphi na kwezi meko, tshintshela kwi-endoscope encinci ye-2.8–3.0 mm.
4. Kubantwana abaneminyaka engaphezulu kwe-8 ubudala kwaye banobunzima obungaphezulu kwe-35 kg, i-endoscope enobubanzi obungaphandle obuyi-4.9 mm okanye ngaphezulu inokukhethwa. Nangona kunjalo, kwi-bronchoscopy eqhelekileyo, ii-endoscope ezincinci azicaphukisi kakhulu isigulana kwaye zinciphisa umngcipheko weengxaki ngaphandle kokuba kufuneka ukungenelela okukhethekileyo.
5. Imodeli ye-EBUS yabantwana ephambili yangoku yeFujifilm yi-EB-530US. Iinkcukacha zayo eziphambili zezi zilandelayo: ububanzi bangaphandle obukude: 6.7 mm, ityhubhu yokufakela ububanzi bangaphandle: 6.3 mm, itshaneli yokusebenza: 2.0 mm, ubude bokusebenza: 610 mm, kunye nobude obupheleleyo: 880 mm. Ubudala kunye nobunzima obucetyiswayo: Ngenxa yobubanzi obukude obuyi-6.7 mm be-endoscope, icetyiswa kubantwana abaneminyaka eli-12 nangaphezulu okanye abanobunzima obungaphezulu kwama-40 kg.
I-Olympus Ultrasonic Bronchoscope: (1) I-Linear EBUS (BF-UC190F Series): ≥Iminyaka eli-12 ubudala, ≥40 kg. (2) I-Radial EBUS + I-Ultrathin Mirror (BF-MP290F Series): ≥Iminyaka eli-6 ubudala, ≥20 kg; kubantwana abancinci, ububanzi beprobe kunye nesipili kufuneka buncitshiswe ngakumbi.
Intshayelelo kwi-bronchoscopy eyahlukeneyo
IiBronchoscopes zahlulwe ngokwesakhiwo sazo kunye nemigaqo yokufota zibe zezi ndidi zilandelayo:
Iibronchoscope zeFiberoptic
Iibronchoscopes ze-elektroniki
Iibronchoscopes ezidibeneyo
Iibronchoscopes ze-Autofluorescence
Iibronchoscopes ze-ultrasound
……
I-bronchoscopy ye-fiberoptic:
I-bronchoscope ye-elektroniki:
I-bronchoscope edibeneyo:
Ezinye ii-bronchoscopes:
Ii-bronchoscopes ze-Ultrasound (EBUS): I-ultrasound probe edityaniswe kwisiphelo esingaphambili se-endoscope ye-elektroniki yaziwa ngokuba yi-"airway B-ultrasound." Ingangena eludongeni lomoya kwaye ibone ngokucacileyo ii-lymph nodes ze-mediastinal, imithambo yegazi, kunye nee-tumor ezingaphandle kwe-trachea. Ifanelekile ngokukodwa kwizigulane ezinomhlaza wemiphunga. Ngokugqobhoza okukhokelwa yi-ultrasound, iisampuli ze-lymph node ze-mediastinal zinokufunyanwa ngokuchanekileyo ukuze kuchongwe ukuba ingaba i-tumor igugile na, okunokuthi kuthintele ukwenzakala kwe-thoracotomy yendabuko. I-EBUS yahlulwe yaba yi-"EBUS enkulu" yokujonga izilonda ezijikeleze imigudu emikhulu yomoya kunye ne-"EBUS encinci" (ene-peripheral probe) yokujonga izilonda zemiphunga ezingaphandle. I-"EBUS enkulu" ibonisa ngokucacileyo ubudlelwane phakathi kwemithambo yegazi, ii-lymph nodes, kunye nezilonda ezihlala kwindawo ngaphakathi kwe-mediastinum ngaphandle kwemigudu yomoya. Ikwavumela ukufunxwa kwenaliti ye-transbronchial ngqo kwisilonda phantsi koqwalaselo lwangempela, ithintela ngempumelelo umonakalo kwimithambo emikhulu ejikelezileyo kunye nezakhiwo zentliziyo, iphucula ukhuseleko kunye nokuchaneka. "I-EBUS encinci" inomzimba omncinci, nto leyo evumela ukuba ikwazi ukubona ngokucacileyo izilonda zemiphunga ezingaphandle apho ii-bronchoscopes eziqhelekileyo zingenakufikelela khona. Xa isetyenziswa ne-introuser sheath, ivumela ukuba kwenziwe isampuli echanekileyo ngakumbi.
I-Bronchoscopy yeFluorescence: I-Immunofluorescence bronchoscopy idibanisa i-bronchoscopes ye-elektroniki eqhelekileyo kunye ne-autofluorescence yeselula kunye netekhnoloji yolwazi ukuchonga izilonda kusetyenziswa umahluko we-fluorescence phakathi kweeseli zethumba kunye neeseli eziqhelekileyo. Phantsi kwamaza athile okukhanya, izilonda ezingaphambi komhlaza okanye iithumba ezikwinqanaba lokuqala zikhupha i-fluorescence eyahlukileyo eyahlukileyo kumbala wezicubu eziqhelekileyo. Oku kunceda oogqirha ukuba bafumane izilonda ezincinci ekunzima ukuzibona nge-endoscopy eqhelekileyo, ngaloo ndlela kuphucula izinga lokufunyaniswa komhlaza wemiphunga kwangethuba.
Iibronchoscopes ezibhityile kakhulu:Ii-bronchoscopes ezincinci kakhulu ziyindlela eguquguqukayo ye-endoscopic enobubanzi obuncinci (ngesiqhelo <3.0 mm). Zisetyenziswa kakhulu ekuhlolweni ngokuchanekileyo okanye kunyango lwemimandla yemiphunga ekude. Inzuzo yazo ephambili ikukwazi kwazo ukubona i-bronchi engaphantsi kwesigaba esingaphantsi kwenqanaba lesi-7, okuvumela ukuvavanywa okuneenkcukacha ngakumbi kwezilonda ezincinci. Zinokufikelela kwi-bronchi encinci ekunzima ukuyifikelela nge-bronchoscopes yendabuko, ukuphucula izinga lokubhaqwa kwezilonda kwangethuba kunye nokunciphisa ukwenzakala kotyando.Uvulindlela ophambili kwi-"navigation + robotics":ukuhlola "ummandla ongaziwayo" wemiphunga.
I-electromagnetic navigation bronchoscopy (ENB) ifana nokuxhobisa i-bronchoscope ngeGPS. Ngaphambi kotyando, imodeli ye-3D lung iyakhiwa kwakhona kusetyenziswa ii-CT scans. Ngexesha lotyando, iteknoloji yokubeka i-electromagnetic ikhokela i-endoscope ngokusebenzisa amasebe e-bronchial antsonkothileyo, ijolise ngqo kumaqhuqhuva amancinci emiphunga ajikeleze ummandla anobukhulu obuziimilimitha ezimbalwa kuphela (ezifana namaqhuqhuva eglasi engaphantsi kwe-5 mm) ukuze kuhlolwe okanye kukhutshwe igazi.
I-bronchoscopy encediswa yirobhothi: I-endoscope ilawulwa yingalo yerobhothi eqhutywa ngugqirha kwi-console, isusa impembelelo yokungcangcazela kwezandla kwaye ifezekise ukuchaneka okuphezulu kokubekwa kwayo. Isiphelo se-endoscope sinokujikeleza iidigri ezingama-360, okuvumela ukuhamba okuguquguqukayo kwiindlela ezixineneyo ze-bronchial. Ilungele ngokukodwa ukuphathwa ngokuchanekileyo ngexesha lotyando oluntsonkothileyo lwemiphunga kwaye sele yenze impembelelo enkulu kwicandelo le-biopsy yamaqhuqhuva amancinci emiphungeni kunye ne-ablation.
Ezinye ii-bronchoscopes zasekhaya:
Ukongeza, iimpawu ezininzi zasekhaya ezifana ne-Aohua kunye ne-Huaguang nazo zilungile.
Makhe sibone ukuba yintoni esinokuyibonelela njengezinto ezisetyenziswayo ze-bronchoscopy
Nazi izinto zethu ezisetyenziswayo ze-endoscopic ezithengiswayo ezithengiswa nge-bronchoscopy.
Iibhrashi zeCytology ezilahlwayo
IiForceps zeBiopsy ezilahlwayo-Iiforceps ze-biopsy ze-1.8mmkwi-bronchoscopy ephinda isetyenziswe
Iiforceps ze-biopsy ze-1.0mmkwi-bronchoscopy elahlwayo
Umgibe we-Polypectomy oyi-1.8mm
Ixesha leposi: Sep-03-2025