Ukuthuthukiswa komlando kwe-bronchoscopy
Umqondo obanzi we-bronchoscope kufanele uhlanganise i-bronchoscope eqinile kanye ne-flexible (flexible) bronchoscope.
1897
Ngo-1897, isazi se-laryngologist saseJalimane uGustav Killian wenza ukuhlinzwa kokuqala kwe-bronchoscopic emlandweni - wasebenzisa i-endoscope yensimbi eqinile ukuze asuse umzimba wangaphandle onamathambo kuqhoqhoqho lesiguli.
1904
UChevalier Jackson e-United States wenza i-bronchoscope yokuqala.
1962
Udokotela waseJapan u-Shigeto Ikeda wasungula i-fiberoptic bronchoscope yokuqala. Le bronchoscope eguquguqukayo, engabonakali, ekala amamilimitha ambalwa nje ububanzi, idlulisa izithombe emashumini ezinkulungwane zemicu yokubona, eyenza ukuthi ifakwe kalula ku-bronchi yezigaba ngisho nangaphansi. Lokhu kuphumelela kwavumela odokotela ukuba babone izakhiwo ekujuleni kwamaphaphu okokuqala ngqa, futhi iziguli zazikwazi ukubekezelela ukuhlolwa ngaphansi kwe-anesthesia yendawo, okuqeda isidingo sokubulala izinzwa okuvamile. Ukufika kwe-fiberoptic bronchoscope kwaguqula i-bronchoscopy isuka enqubweni ehlaselayo yaya ekuhloleni okungavamisile, okwenza kube lula ukutholakala kwezifo ezinjengomdlavuza wamaphaphu nesifo sofuba.
1966
NgoJulayi 1966, uMachida wakhiqiza i-fiberoptic bronchoscope yokuqala yeqiniso emhlabeni. Ngo-August 1966, i-Olympus nayo yakhiqiza i-fiberoptic bronchoscope yayo yokuqala. Kamuva, iPentax neFuji eJapane, kanye neWolf yaseJalimane, nazo zakhulula ama-bronchoscopes azo.
I-Fiberoptic bronchoscope:
I-Olympus XP60, ububanzi obungaphandle buyi-2.8mm, isiteshi se-biopsy 1.2mm
I-bronchoscope ehlanganisiwe:
I-Olympus XP260, ububanzi obungaphandle obungu-2.8mm, isiteshi se-biopsy 1.2mm
Umlando we-bronchoscopy yezingane e-China
Ukusetshenziswa komtholampilo kwe-fiberoptic bronchoscopy ezinganeni ezweni lami kwaqala ngo-1985, kwaqalwa izibhedlela zezingane eBeijing, Guangzhou, Tianjin, Shanghai, naseDalian. Ekwakhela phezu kwalesi sisekelo, ngo-1990 (esasungulwa ngokusemthethweni ngo-1991), uSolwazi Liu Xicheng, ngaphansi kokuqondisa kukaSolwazi Jiang Zaifang, wasungula igumbi lokuqala laseChina le-bronchoscopy yezingane eSibhedlela Sezingane saseBeijing esixhumene ne-Capital Medical University, okumaka ukusungulwa ngokusemthethweni kohlelo lwezobuchwepheshe lwe-bronchoscopy lwezingane lwaseChina. Ukuhlolwa kokuqala kwe-fiberoptic bronchoscopy enganeni kwenziwa uMnyango Wokuphefumula eSibhedlela Sezingane esixhumene ne-Zhejiang University School of Medicine ngo-1999, okwenza kwaba ngesinye sezikhungo zokuqala e-China ukusebenzisa ngokuhlelekile ukuhlolwa kwe-fiberoptic bronchoscopy kanye nokwelashwa kwezingane.
Ububanzi be-tracheal yezingane ezineminyaka ehlukene
Ungakhetha kanjani amamodeli ahlukene we-bronchoscopes?
Ukukhethwa kwemodeli ye-bronchoscope yezingane kufanele kunqunywe ngokusekelwe eminyakeni yobudala besiguli, usayizi wendlela yokuphefumula, kanye nokuxilongwa okuhlosiwe kanye nokwelashwa. "Iziqondiso Ze-Pediatric Flexible Bronchoscopy e-China (Ushicilelo luka-2018)" nezinto ezihlobene nazo ziyizinkomba eziyinhloko.
Izinhlobo ze-bronchoscope ngokuyinhloko zihlanganisa ama-bronchoscopes e-fiberoptic, ama-bronchoscopes kagesi, nama-bronchoscopes ahlangene. Kunemikhiqizo eminingi yasekhaya emisha emakethe, eminingi yayo ingeyekhwalithi ephezulu. Umgomo wethu uwukuthola umzimba omncane, ama-forceps amakhulu, nezithombe ezicacile.
Ezinye ze-bronchoscopes eziguquguqukayo ziyethulwa:
Ukukhetha Imodeli:
1. Ama-bronchoscope anobubanzi obungu-2.5-3.0mm:
Ifanele wonke amaqembu eminyaka yobudala (kuhlanganise nezinsana). Okwamanje atholakalayo emakethe ama-bronchoscope anobubanzi obungaphandle obungu-2.5mm, 2.8mm, no-3.0mm, kanye nesiteshi esisebenzayo esingu-1.2mm. Lawa ma-bronchoscopes angenza i-aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), i-laser dilatation, kanye nokwelula ibhaluni ngesigaba sokunwebeka sangaphambi kobubanzi obungu-1mm kanye nama-stents ensimbi.
2. Ama-bronchoscope anobubanzi obungu-3.5-4.0 mm:
Ngokwethiyori, lokhu kulungele izingane ezingaphezu konyaka owodwa ubudala. Isiteshi sayo esisebenzayo esingu-2.0 mm sivumela izinqubo ezifana ne-electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), dilatation ibhaluni, kanye nokubekwa kwe-stent.
I-Olympus BF-MP290F iyi-bronchoscope enobubanzi obungaphandle obungu-3.5 mm kanye nesiteshi esingu-1.7 mm. Ithiphu ububanzi bangaphandle: 3.0 mm (ingxenye yokufaka ≈ 3.5 mm); ububanzi bangaphakathi besiteshi: 1.7 mm. Ivumela ukudlula kwe-forceps ye-biopsy engu-1.5 mm, ama-ultrasound probes angu-1.4 mm, namabhulashi angu-1.0 mm. Qaphela ukuthi i-biopsy forceps engu-2.0 mm ububanzi ayikwazi ukungena kulesi siteshi. Imikhiqizo yasekhaya efana ne-Shixin nayo inikezela ngezici ezifanayo. Isizukulwane esilandelayo sama-bronchoscopes esizukulwane esilandelayo se-Fujifilm i-EB-530P kanye ne-EB-530S afaka ububanzi obuncane kakhulu obunobubanzi obungaphandle obungu-3.5 mm kanye neshaneli yobubanzi obuyi-1.2 mm yangaphakathi. Zifanele ukuhlolwa nokungenelela kwezilonda zamaphaphu aseduze kokubili kwezingane kanye nezilungiselelo zabantu abadala. Ahambisana namabhulashi e-cytology angu-1.0 mm, i-forceps ye-biopsy engu-1.1 mm, kanye ne-forcep yomzimba yangaphandle engu-1.2 mm.
3. Ama-bronchoscope anobubanzi obungu-4.9 mm noma ngaphezulu:
Ngokuvamile ifanele izingane ezineminyaka engu-8 nangaphezulu enesisindo esingu-35 kg noma ngaphezulu. Isiteshi esisebenzayo esingu-2.0 mm sivumela izinqubo ezifana ne-electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), ukunwetshwa kwebhaluni, nokubekwa kwe-stent. Amanye ama-bronchoscope anesiteshi esisebenzayo esikhulu kuno-2 mm, okuwenza alungele izinqubo zokungenelela.
Ububanzi
4. Izimo Ezikhethekile: Ama-bronchoscope e-Ultrathin anobubanzi obungaphandle obungu-2.0 mm noma 2.2 mm futhi akukho siteshi esisebenzayo esingasetshenziswa ukuhlola imigudu yomoya emincane ekude yezingane ezizalwa ngaphambi kwesikhathi noma ezigcwele isikhathi esigcwele. Zifanele futhi ukuhlolwa kwendlela yokuphefumula ezinsaneni ezisencane ezine-stenosis enzima yokuphefumula.
Ngamafuphi, imodeli efanelekile kufanele ikhethwe ngokusekelwe eminyakeni yobudala yesiguli, usayizi wendlela yokuphefumula, kanye nezidingo zokuxilonga nokwelashwa ukuze kuqinisekiswe inqubo ephumelelayo nephephile.
Ezinye izinto okufanele uziqaphele lapho ukhetha isibuko:
Nakuba ama-bronchoscopes anobubanzi obungu-4.0mm angaphandle afanele izingane ezineminyaka engaphezu kuka-1 ubudala, ekusebenzeni kwangempela, ama-bronchoscopes angaphandle angu-4.0mm anzima ukufinyelela ilume ejulile ye-bronchial yezingane ezineminyaka engu-1-2 ubudala. Ngakho-ke, ezinganeni ezingaphansi konyaka owodwa ubudala, oneminyaka engu-1-2 ubudala, futhi ezinesisindo esingaphansi kuka-15kg, ama-bronchoscopes azacile angu-2.8mm noma 3.0mm angaphandle asetshenziselwa ukwenza imisebenzi evamile.
Ezinganeni ezineminyaka engu-3-5 ubudala kanye nesisindo esingu-15kg-20kg, ungakhetha isibuko esincane esinobubanzi obungaphandle obungu-3.0mm noma isibuko esinobubanzi obungaphandle obungu-4.2mm. Uma ukuthwebula kukhombisa ukuthi kunendawo enkulu ye-atelectasis kanye nepulaki lesikhwehlela okungenzeka ukuthi livinjwe, kutuswa ukuthi kusetshenziswe isibuko esinobubanzi obungaphandle obungu-4.2mm kuqala, esikhanga ngamandla futhi esingadonswa. Kamuva, isibuko esincanyana esingu-3.0mm singasetshenziselwa ukubhoboza okujulile nokuhlola. Uma kucatshangelwa i-PCD, i-PBB, njll, futhi izingane zijwayele ukukhishwa kwe-purulent, kunconywa futhi ukukhetha isibuko esiqinile esinobubanzi obungaphandle obungu-4.2mm, okulula ukukhanga. Ngaphezu kwalokho, isibuko esinobubanzi obungaphandle obungu-3.5mm singasetshenziswa.
Ezinganeni ezineminyaka engu-5 noma ngaphezulu kanye nesisindo esingu-20 kg noma ngaphezulu, i-bronchoscope yangaphandle engu-4.2 mm ngokuvamile ikhethwa. Ishaneli ye-forceps engu-2.0 mm isiza ukukhohlisa nokumunca.
Nokho, i-bronchoscope ezacile engu-2.8/3.0 mm yangaphandle kufanele ikhethwe kulezi zimo ezilandelayo:
① I-anatomical airway stenosis:
• I-Congenital or postoperative airway stenosis, tracheobronchomalacia, noma i-extrinsic compression stenosis. • Idayamitha yangaphakathi ye-subglottic noma ingxenye encane ye-bronchial <5 mm.
② Ukuhlukumezeka kwakamuva kwendlela yomoya noma i-edema
• I-post-intubation glottic/subglottic edema, ukusha kwe-endotracheal, noma ukulimala ngokuhogela.
③ I-stridor enzima noma ukucindezeleka kokuphefumula
• I-laryngotracheobronchitis ebukhali noma isimo esibucayi se-asthmaticus esidinga ukucasuka okuncane.
④ Umzila wamakhala onezikhala ezincane
• I-stenosis ebalulekile ye-vestibule yamakhala noma i-turbinate engaphansi ngesikhathi sokufakwa kwekhala, okuvimbela ukudlula kwe-endoscope engu-4.2 mm ngaphandle kokulimala.
⑤ Isidingo sokungena ku-peripheral (ibanga lesi-8 noma ngaphezulu) i-bronchus.
• Kwezinye izimo ze-Mycoplasma pneumonia enzima ene-atelectasis, uma ama-alveolar lavages amaningi e-bronchoscopic esigabeni esibucayi asahluleka ukubuyisela i-atelectasis, kungase kudingeke i-endoscope enhle ukuze kubhoboze ku-distal bronchoscope ukuze kuhlolwe futhi kwelashwe amapulaki esikhwehlela amancane, ajulile. • Ezimeni okusoleka ukuthi yi-bronchial obstruction (BOB), okulandela inyumoniya enzima, i-endoscope enhle ingase isetshenziselwe ukubhoboza ngokujulile emagatsheni amancane namagatsha engxenye yamaphaphu ethintekile. • Ezimeni ze-congenital bronchial atresia, ukubhoboza okujulile nge-endoscope ecolekile kuyadingeka futhi ku-bronchial atresia ejulile. • Ukwengeza, ezinye izilonda ezisezindaweni ezizungezile (ezifana nokusabalalisa ukopha kwe-alveolar kanye nezigaxana ze-peripheral) zidinga i-endoscope ecolekile.
⑥ Ukukhubazeka komlomo wesibeletho noma kwe-maxillofacial okuhambisanayo
• I-Micromandibular noma i-craniofacial syndromes (njenge-Pierre-Robin syndrome) ekhawulela isikhala se-oropharyngeal.
⑦ Isikhathi esifushane senqubo, esidinga ukuhlolwa kokuxilonga kuphela
• Kudingeka i-BAL kuphela, ukuxubha, noma i-biopsy elula; azikho izinsimbi ezinkulu ezidingekayo, futhi i-endoscope encane inganciphisa ukucasuka.
⑧ Ukulandelela ngemuva kokuhlinzwa
• I-bronchoscopy eqinile yakamuva noma ukunwetshwa kwebhaluni ukuze kuncishiswe ukuhlukumezeka kwesibili kwe-mucosal.
Kafushane:
"I-Stenosis, i-edema, ukuphefumula, i-nares encane, i-periphery ejulile, ukukhubazeka, isikhathi esifushane sokuhlolwa, nokululama ngemva kokuhlinzwa" -uma kukhona noma yiziphi zalezi zimo, shintshela ku-endoscope encane engu-2.8-3.0 mm.
4. Ezinganeni ezineminyaka engu->8 ubudala kanye nesisindo esingu->35 kg, i-endoscope enobubanzi obungaphandle obungu-4.9 mm noma ngaphezulu ingakhethwa. Kodwa-ke, nge-bronchoscopy evamile, ama-endoscopes amancane awacasuli isiguli futhi anciphisa ingozi yezinkinga ngaphandle uma kudingeka ukungenelela okukhethekile.
5. Imodeli yamanje ye-EBUS yezingane eyinhloko ye-Fujifilm i-EB-530US. Ukucaciswa kwayo okubalulekile kungokulandelayo: ububanzi obungaphandle obukude: 6.7 mm, ishubhu yokufaka ububanzi obungaphandle: 6.3 mm, isiteshi esisebenzayo: 2.0 mm, ubude bokusebenza: 610 mm, nobude obuphelele: 880 mm. Iminyaka yobudala nesisindo esinconyiwe: Ngenxa yobubanzi obuyi-6.7 mm be-endoscope, inconywa ezinganeni ezineminyaka engu-12 nangaphezulu noma ezinesisindo esingaphezulu kuka-40 kg.
I-Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥iminyaka engu-12 ubudala, ≥40 kg. (2) I-Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 iminyaka ubudala, ≥20 kg; ezinganeni ezincane, i-probe kanye nama-diameters wesibuko kudingeka kuncishiswe nakakhulu.
Isingeniso se-bronchoscopy ehlukahlukene
Ama-bronchoscopes ahlukaniswa ngokuya ngesakhiwo sawo kanye nezimiso zokucabanga ngezigaba ezilandelayo:
I-Fiberoptic bronchoscopes
I-bronchoscope ye-elekthronikhi
I-bronchoscopes ehlanganisiwe
I-Autofluorescence bronchoscopes
I-Ultrasound bronchoscopes
……
I-Fiberoptic bronchoscopy:
I-bronchoscope ye-elekthronikhi:
I-bronchoscope ehlanganisiwe:
Amanye ama-bronchoscopes:
I-Ultrasound bronchoscopes (EBUS): I-ultrasound probe ehlanganiswe ekugcineni kwe-endoscope ye-electronic yaziwa ngokuthi "i-airway B-ultrasound." Ingangena odongeni lomzila womoya futhi ibone ngokucacile ama-lymph nodes e-mediastinal, imithambo yegazi, namathumba angaphandle koqhoqhoqho. Ilungele ikakhulukazi iziguli ezinomdlavuza wamaphaphu. Ngokubhoboza okuqondiswa yi-ultrasound, amasampula e-lymph node ye-mediastinal angatholwa ngokunembile ukuze kunqunywe ukuthi isimila simetastasized, okungenzeka kugwenywe ukuhlukumezeka kwethoracotomy yendabuko. I-EBUS ihlukaniswe ngokuthi "i-EBUS enkulu" yokubheka izilonda ezizungeze imigudu yomoya emikhulu kanye "ne-EBUS encane" (ene-peripheral probe) yokubheka izilonda ezisezindaweni zamaphaphu. "I-EBUS enkulu" ikhombisa ngokusobala ubudlelwano phakathi kwemithambo yegazi, ama-lymph nodes, nezilonda ezithatha isikhala ngaphakathi kwe-mediastinum ngaphandle kwemigudu yomoya. Iphinde ivumele i-aspiration ye-transbronchial inaliti ngqo esilonda ngaphansi kokuqapha kwesikhathi sangempela, ukugwema ngokuphumelelayo ukulimala kwemikhumbi emikhulu ezungezile nezakhiwo zenhliziyo, ukuthuthukisa ukuphepha nokunemba. "I-EBUS encane" inomzimba omncane, okuwuvumela ukuba ubone ngeso lengqondo izilonda zamaphaphu aseduze lapho i-bronchoscopes evamile ingakwazi ukufinyelela khona. Uma isetshenziswa neshethi yesethulo, ivumela amasampula anembe kakhudlwana.
I-Fluorescence bronchoscopy: I-Immunofluorescence bronchoscopy ihlanganisa ama-bronchoscopes e-electronic avamile ne-autofluorescence yamaselula kanye nobuchwepheshe bolwazi ukuze kutholakale izilonda kusetshenziswa umehluko we-fluorescence phakathi kwamaseli wesimila namaseli avamile. Ngaphansi kobude obuthile bokukhanya, izilonda ezingaphambi komdlavuza noma izimila ezisanda kuqala zikhipha i-fluorescence ehlukile ehlukile kumbala wezicubu ezivamile. Lokhu kusiza odokotela ukuthi babone izilonda ezincane okunzima ukuzibona nge-endoscopy evamile, ngaleyo ndlela kuthuthukiswe izinga lokuxilongwa kusenesikhathi komdlavuza wamaphaphu.
Ama-bronchoscopes amancane kakhulu:Ama-bronchoscopes azacile kakhulu ayindlela ye-endoscopic eguquguqukayo enobubanzi obuncane (imvamisa engu-<3.0 mm). Ngokuyinhloko zisetshenziselwa ukuhlolwa okunembile noma ukwelashwa kwezifunda zamaphaphu akude. Inzuzo yabo eyinhloko isemandleni abo okubona ngeso lengqondo i-bronchi engaphansi kweleveli 7, okuvumela ukuhlolwa okuningiliziwe kwezilonda ezicashile. Bangakwazi ukufinyelela i-bronchi encane okunzima ukufinyelela kuyo ngama-bronchoscopes endabuko, ukuthuthukisa izinga lokutholwa kwezilonda zakuqala kanye nokunciphisa ukuhlukumezeka kokuhlinzwa.Iphayona eliphambili ku-"navigation + robotics":ukuhlola "indawo engashadiwe" yamaphaphu.
I-Electromagnetic navigation bronchoscopy (ENB) ifana nokuhlomisa i-bronchoscope nge-GPS. Ngaphambi kokuhlinzwa, imodeli yamaphaphu ye-3D yakhiwa kabusha kusetshenziswa izikena ze-CT. Ngesikhathi sokuhlinzwa, ubuchwepheshe bokumisa kazibuthe buqondisa i-endoscope ngamagatsha e-bronchial ayinkimbinkimbi, buqondise ngokunembile izigaxana zamaphaphu asemgwaqweni ezikala amamilimitha ambalwa kuphela ububanzi (njengamaqhuqhuva engilazi ephansi angaphansi kuka-5 mm) ukuze kutholakale i-biopsy noma i-ablation.
I-bronchoscopy yerobhothi: I-endoscope ilawulwa ingalo yerobhothi esetshenziswa udokotela kukhonsoli, iqeda ithonya lokundindizela kwezandla futhi izuze ukunemba kokuma okuphezulu. Ukuphela kwe-endoscope kungazungezisa amadigri angu-360, okuvumela ukuzulazula okuguquguqukayo emizila ye-bronchial ehlukumezayo. Ifaneleka kahle kakhulu ukukhohliswa okunembile phakathi nokuhlinzwa okuyinkimbinkimbi kwamaphaphu futhi isivele yenze umthelela obalulekile emikhakheni ye-biopsy yamaqhuqhuva amaphaphu amancane kanye nokukhishwa kwesisu.
Amanye ama-bronchoscopes asekhaya:
Ngaphezu kwalokho, izinhlobo eziningi zasekhaya ezifana ne-Aohua ne-Huaguang nazo zilungile.
Ake sibone ukuthi yini esinganikeza ngayo njengezinto ezisetshenziswayo ze-bronchoscopy
Nazi izinto zethu ezisetshenziswayo ze-endoscopic ezihambisana ne-bronchoscopy ezithengiswayo ezishisayo.
Amabhulashi e-Cytology alahlwayo
Ama-Biopsy Forceps alahlwayo-1.8mm biopsy forcepsye-bronchoscopy engasetshenziswa kabusha
1.0mm biopsy forcepsye-bronchoscopy elahlwayo
Isikhathi sokuthumela: Sep-03-2025