Ukuthuthukiswa komlando kwe-bronchoscopy
Umqondo obanzi we-bronchoscope kufanele uhlanganise i-bronchoscope eqinile kanye ne-bronchoscope eguquguqukayo (eguquguqukayo).
1897
Ngo-1897, isazi se-laryngologist saseJalimane uGustav Killian senza ukuhlinzwa kokuqala kwe-bronchoscopic emlandweni - wasebenzisa i-endoscope yensimbi eqinile ukususa umzimba wangaphandle onethambo ku-trachea yesiguli.
1904
UChevalier Jackson e-United States wakha i-bronchoscope yokuqala.
1962
Udokotela waseJapan uShigeto Ikeda wasungula i-bronchoscope yokuqala ye-fiberoptic. Le bronchoscope eguquguqukayo, encane kakhulu, enobubanzi obungamamilimitha ambalwa nje, yadlulisela izithombe ngemicu ye-optical eyizinkulungwane ezingamashumi, okwenza kube lula ukufaka ku-bronchi ehlukaniswe izingxenye ngisho nangaphansi kwezingxenye. Lokhu kuphumelela kwavumela odokotela ukuthi babone izakhiwo ezijulile emaphashini okokuqala, futhi iziguli zakwazi ukubekezelela ukuhlolwa ngaphansi kwe-anesthesia yendawo, kwasusa isidingo se-anesthesia ejwayelekile. Ukufika kwe-bronchoscope ye-fiberoptic kwashintsha i-bronchoscopy kusukela enkambisweni yokuhlasela kuya ekuhlolweni okungenakuhlasela okuningi, kwasiza ekuxilongweni kwasekuqaleni kwezifo ezifana nomdlavuza wamaphaphu nesifo sofuba.
1966
NgoJulayi 1966, uMachida wakhiqiza i-bronchoscope yokuqala ye-fiberoptic emhlabeni. Ngo-Agasti 1966, i-Olympus yakhiqiza ne-bronchoscope yayo yokuqala ye-fiberoptic. Ngemva kwalokho, i-Pentax ne-Fuji eJapane, kanye ne-Wolf eJalimane, nazo zakhipha ama-bronchoscope azo.
I-bronchoscope ye-fiberoptic:
I-Olympus XP60, ububanzi bangaphandle obungu-2.8mm, isiteshi se-biopsy esingu-1.2mm
I-bronchoscope ehlanganisiwe:
I-Olympus XP260, ububanzi bangaphandle obungu-2.8mm, isiteshi se-biopsy esingu-1.2mm
Umlando we-bronchoscopy yezingane eShayina
Ukusetshenziswa kwe-fiberoptic bronchoscopy emtholampilo ezinganeni ezweni lakithi kwaqala ngo-1985, kwaqalwa yizibhedlela zezingane eBeijing, eGuangzhou, eTianjin, eShanghai, naseDalian. Ngokwakhela phezu kwalesi sisekelo, ngo-1990 (eyasungulwa ngokusemthethweni ngo-1991), uSolwazi uLiu Xicheng, ngaphansi kokuqondiswa nguSolwazi uJiang Zaifang, wasungula igumbi lokuqala laseShayina le-bronchoscopy yezingane eBeijing Children's Hospital elihambisana neCapital Medical University, okwaphawula ukusungulwa okusemthethweni kohlelo lobuchwepheshe be-bronchoscopy yezingane eShayina. Ukuhlolwa kokuqala kwe-fiberoptic bronchoscopy enganeni kwenziwa yi-Respiratory Department e-Children's Hospital elihambisana neZhejiang University School of Medicine ngo-1999, okwenza kwaba ngesinye sezikhungo zokuqala eShayina ukusebenzisa ngokuhlelekile ukuhlolwa kwe-fiberoptic bronchoscopy kanye nokwelashwa kwezingane.
Ububanzi be-trachea yezingane ezineminyaka ehlukene
Ungakhetha kanjani amamodeli ahlukene e-bronchoscopes?
Ukukhetha imodeli ye-bronchoscope yezingane kufanele kunqunywe ngokusekelwe eminyakeni yesiguli, usayizi womoya, kanye nokuxilongwa kanye nokwelashwa okuhlosiwe. "Iziqondiso ze-Pediatric Flexible Bronchoscopy eShayina (Uhlelo luka-2018)" kanye nezinto ezihlobene nazo yizona eziyinhloko ezibhekisela kuzo.
Izinhlobo ze-bronchoscope zifaka phakathi ama-bronchoscope e-fiberoptic, ama-bronchoscope e-elekthronikhi, kanye nama-bronchoscope ahlanganisiwe. Kunezinhlobo eziningi ezintsha zasekhaya emakethe, eziningi zazo ezisezingeni eliphezulu. Umgomo wethu ukufeza umzimba omncane, ama-forceps amakhulu, kanye nezithombe ezicacile.
Amanye ama-bronchoscope aguquguqukayo afakwa:
Ukukhetha Imodeli:
1. Ama-Bronchoscope anobubanzi obungu-2.5-3.0mm:
Kufanelekela wonke amaqembu eminyaka (kufaka phakathi izingane ezisanda kuzalwa). Okwamanje kutholakala emakethe ama-bronchoscope anobubanzi bangaphandle obungu-2.5mm, 2.8mm, kanye no-3.0mm, kanye nomzila osebenzayo ongu-1.2mm. Lawa ma-bronchoscope angenza ukufutha, ukufaka umoya-mpilo, ukugeza, i-biopsy, ukuxubha (i-fine-bristle), ukukhulisa nge-laser, kanye nokukhulisa ibhaluni ngesigaba sangaphambi kokukhulisa esingu-1mm ububanzi kanye nama-stents ensimbi.
2. Ama-Bronchoscope anobubanzi obungu-3.5-4.0 mm:
Ngokwethiyori, lokhu kufaneleka ezinganeni ezingaphezu konyaka owodwa ubudala. Isiteshi sayo sokusebenza esingu-2.0 mm sivumela izinqubo ezifana ne-electrocoagulation, i-cryoablation, i-transbronchial needle aspiration (TBNA), i-transbronchial lung biopsy (TBLB), i-balloon dilatation, kanye nokubekwa kwe-stent.
I-Olympus BF-MP290F iyi-bronchoscope enobubanzi bangaphandle obungu-3.5 mm kanye nesiteshi esingu-1.7 mm. Ububanzi bangaphandle obuphezulu: 3.0 mm (ingxenye yokufaka ≈ 3.5 mm); ububanzi bangaphakathi besiteshi: 1.7 mm. Ivumela ukudlula kwe-1.5 mm biopsy forceps, 1.4 mm ultrasound probes, kanye namabhulashi angu-1.0 mm. Qaphela ukuthi i-2.0 mm diameter biopsy forceps ayikwazi ukungena kulesi siteshi. Imikhiqizo yasekhaya efana ne-Shixin nayo inikeza imininingwane efanayo. I-Fujifilm's next-generation EB-530P kanye ne-EB-530S series bronchoscopes ifaka i-scope encane kakhulu enobubanzi bangaphandle obungu-3.5 mm kanye nesiteshi sangaphakathi esinobubanzi obungu-1.2 mm. Zifanele ukuhlolwa kanye nokungenelela kwezilonda zamaphaphu ezingaphandle kokubili ezindaweni zezingane kanye nabantu abadala. Ziyahambisana namabhulashi e-cytology angu-1.0 mm, i-1.1 mm biopsy forceps, kanye ne-1.2 mm body forceps.
3. Ama-Bronchoscope anobubanzi obungu-4.9 mm noma ngaphezulu:
Ngokuvamile ifanelekela izingane ezineminyaka engu-8 nangaphezulu enesisindo esingu-35 kg noma ngaphezulu. Isiteshi sokusebenza esingu-2.0 mm sivumela izinqubo ezifana ne-electrocoagulation, i-cryoablation, i-transbronchial needle aspiration (TBNA), i-transbronchial lung biopsy (TBLB), i-balloon dilatation, kanye nokubekwa kwe-stent. Amanye ama-bronchoscopes anesiteshi sokusebenza esingaphezu kuka-2 mm, okwenza kube lula kakhulu ngezinqubo zokungenelela.
Ububanzi
4. Amacala Akhethekile: Ama-bronchoscope amancane kakhulu anobubanzi obungaphandle obungu-2.0 mm noma u-2.2 mm futhi akukho siteshi esisebenzayo esingasetshenziswa ukuhlola izindlela zokuphefumula ezincane ezikude zezinsana ezizalwa ngaphambi kwesikhathi noma ezizalwa ngokugcwele. Zifanele futhi ukuhlolwa kwezindlela zokuphefumula ezinganeni ezincane ezine-stenosis enzima yomoya.
Ngamafuphi, imodeli efanele kufanele ikhethwe ngokusekelwe eminyakeni yesiguli, usayizi womoya, kanye nezidingo zokuxilonga kanye nokwelashwa ukuqinisekisa inqubo ephumelelayo nephephile.
Ezinye izinto okufanele uziqaphele lapho ukhetha isibuko:
Nakuba ama-bronchoscope angaphandle angu-4.0mm ubukhulu afanelekela izingane ezingaphezu konyaka owodwa ubudala, ekusebenzeni kwangempela, ama-bronchoscope angaphandle angu-4.0mm ubukhulu kunzima ukufinyelela i-lumen ejulile ye-bronchial yezingane ezineminyaka engu-1-2 ubudala. Ngakho-ke, ezinganeni ezingaphansi konyaka owodwa ubudala, unyaka owodwa-2, futhi ezinesisindo esingaphansi kuka-15kg, ama-bronchoscope amancane angu-2.8mm noma angu-3.0mm ububanzi avame ukusetshenziswa emisebenzini evamile.
Ezinganeni ezineminyaka engu-3-5 futhi ezinesisindo esingu-15kg-20kg, ungakhetha isibuko esincane esinobubanzi bangaphandle obungu-3.0mm noma isibuko esinobubanzi bangaphandle obungu-4.2mm. Uma izithombe zibonisa ukuthi kunendawo enkulu ye-atelectasis futhi ipulaki yesikhohlela kungenzeka ivinjwe, kunconywa ukusebenzisa isibuko esinobubanzi bangaphandle obungu-4.2mm kuqala, esinokukhanga okunamandla futhi esingadonswa ngaphandle. Kamuva, isibuko esincane esingu-3.0mm singasetshenziswa ukubhoboza okujulile nokuhlola. Uma kucatshangelwa i-PCD, i-PBB, njll., futhi izingane zithambekele ekwehleni okukhulu kwe-purulent, kunconywa futhi ukukhetha isibuko esikhulu esinobubanzi bangaphandle obungu-4.2mm, okulula ukusidonsela. Ngaphezu kwalokho, isibuko esinobubanzi bangaphandle obungu-3.5mm naso singasetshenziswa.
Ezinganeni ezineminyaka emi-5 noma ngaphezulu futhi ezinesisindo esingama-20 kg noma ngaphezulu, i-bronchoscope yangaphandle enobubanzi obungu-4.2 mm ngokuvamile iyathandwa. Isiteshi se-forceps esingu-2.0 mm senza kube lula ukuphatha nokumunca.
Kodwa-ke, i-bronchoscope encane kakhulu enobubanzi obungu-2.8/3.0 mm kufanele ikhethwe ezimweni ezilandelayo:
① Ukuqina komgudu womoya:
• I-stenosis yomoya wokuzalwa noma ngemva kokuhlinzwa, i-tracheobronchomalacia, noma i-stenosis yokucindezela kwangaphandle. • Ububanzi bangaphakathi bengxenye ye-bronchial engaphansi noma encane kakhulu < 5 mm.
② Ukulimala kwamuva komoya noma ukuvuvukala
• Ukuvuvukala kwe-glottic/subglottic ngemuva kokufakwa kwepayipi, ukusha kwe-endotracheal, noma ukulimala kokuphefumula.
③ I-stridor enzima noma ukucindezeleka kokuphefumula
• I-laryngotracheobronchitis ebukhali noma i-asthmatic yesimo esibi esidinga ukucasuka okuncane.
④ Indlela yokungena ekhaleni enezimbobo ezincane zekhala
• Ukuvaleka okukhulu kwe-vestibule yamakhala noma i-inferior turbinate ngesikhathi sokufakwa kwamakhala, okuvimbela ukudlula kwe-endoscope engu-4.2 mm ngaphandle kokulimala.
⑤ Isidingo sokungena ebhulohweni elingaphandle (ibanga lesi-8 noma ngaphezulu).
• Kwezinye izimo ze-Mycoplasma pneumonia enzima ene-atelectasis, uma ukuhlanzwa okuningi kwe-alveolar nge-bronchoscopic esigabeni esibuhlungu kusahluleka ukubuyisela i-atelectasis, kungadingeka i-endoscope encane ukuze kubholwe ngokujulile ku-bronchoscope ekude ukuze kuhlolwe futhi kwelashwe ama-sputum plug amancane, ajulile. • Ezimweni okusolwa ukuthi kukhona ukuvinjelwa kwe-bronchial (BOB), okuwumphumela we-pneumonia enzima, i-endoscope encane ingasetshenziswa ukubhoboza ngokujulile emagatsheni angaphansi nasemagatsheni angaphansi kwesigaba samaphaphu esithintekile. • Ezimweni ze-atresia ye-bronchial yokuzalwa, ukubhoboza ngokujulile nge-endoscope encane nakho kuyadingeka ku-atresia ye-bronchial ejulile. • Ngaphezu kwalokho, ezinye izilonda ezisakazekile zangaphandle (njengokuphuma kwegazi kwe-alveolar okusakazekile kanye nama-nodule angaphandle) zidinga i-endoscope encane.
⑥ Ukukhubazeka komlomo wesibeletho noma ubuso obuphezulu
• Izifo ze-micromandibular noma ze-craniofacial (njenge-Pierre-Robin syndrome) ezivimbela isikhala se-oropharyngeal.
⑦ Isikhathi esifushane senqubo, esidinga ukuhlolwa kokuxilonga kuphela
• Kudingeka i-BAL kuphela, ukuxubha, noma i-biopsy elula; azikho izinto ezinkulu ezidingekayo, futhi i-endoscope encane inganciphisa ukucasuka.
⑧ Ukulandelela ngemva kokuhlinzwa
• Ukwanda kwe-bronchoscopy noma i-balloon muva nje ukuze kuncishiswe ukulimala kwesibili kwe-mucosal.
Kafushane:
"I-stenosis, ukuvuvukala, ukuphefumula okunzima, izinhlungu ezincane, umngcele ojulile, ukukhubazeka, isikhathi esifushane sokuhlolwa, kanye nokululama ngemva kokuhlinzwa"—uma kukhona noma yiziphi zalezi zimo, shintshela ku-endoscope encane engu-2.8–3.0 mm.
4. Ezinganeni ezineminyaka engaphezu kwengu-8 futhi ezinesisindo esingaphezu kwama-35 kg, i-endoscope enobubanzi obungaphandle obungu-4.9 mm noma ngaphezulu ingakhethwa. Kodwa-ke, kwi-bronchoscopy evamile, ama-endoscope amancane awacasuli kakhulu isiguli futhi anciphisa ingozi yezinkinga ngaphandle kokuthi kudingeka ukungenelela okukhethekile.
5. Imodeli ye-EBUS yabantwana eyinhloko yamanje ye-Fujifilm yi-EB-530US. Imininingwane yayo ebalulekile yile: ububanzi bangaphandle obude: 6.7 mm, ithubhu yokufaka ububanzi bangaphandle: 6.3 mm, isiteshi sokusebenza: 2.0 mm, ubude bokusebenza: 610 mm, kanye nobude obuphelele: 880 mm. Ubudala nesisindo esinconywayo: Ngenxa yobubanzi obude obude obungu-6.7 mm be-endoscope, kunconywa izingane ezineminyaka engu-12 nangaphezulu noma ezinesisindo esingaphezu kuka-40 kg.
I-Olympus Ultrasonic Bronchoscope: (1) I-Linear EBUS (Uchungechunge lwe-BF-UC190F): ≥iminyaka engu-12 ubudala, ≥40 kg. (2) I-Radial EBUS + Ultrathin Mirror (Uchungechunge lwe-BF-MP290F): ≥iminyaka engu-6 ubudala, ≥20 kg; ezinganeni ezincane, ububanzi be-probe kanye nesibuko kudingeka buncishiswe kakhulu.
Isingeniso ku-bronchoscopy ehlukahlukene
Ama-bronchoscope ahlukaniswa ngokwesakhiwo sawo kanye nezimiso zokuthwebula izithombe ngezigaba ezilandelayo:
Ama-bronchoscope e-fiberoptic
Ama-bronchoscope kagesi
Ama-bronchoscope ahlanganisiwe
Ama-bronchoscope e-Autofluorescence
Ama-bronchoscope e-ultrasound
……
I-bronchoscopy ye-fiberoptic:
I-bronchoscope kagesi:
I-bronchoscope ehlanganisiwe:
Amanye ama-bronchoscope:
Ama-bronchoscope e-Ultrasound (i-EBUS): I-probe ye-ultrasound ehlanganiswe engxenyeni engaphambili ye-endoscope ye-elekthronikhi yaziwa ngokuthi "i-airway B-ultrasound." Ingangena odongeni lomoya futhi ibone ngokucacile ama-lymph node e-mediastinal, imithambo yegazi, kanye nama-tumors angaphandle kwe-trachea. Ifaneleka kakhulu ezigulini ezinomdlavuza wamaphaphu. Ngokubhoboza okuqondiswa yi-ultrasound, amasampula e-lymph node e-mediastinal angatholakala ngokunembile ukuze kunqunywe ukuthi isimila sisakazeke yini, okungenzeka kugwenywe ukulimala kwe-thoracotomy yendabuko. I-EBUS ihlukaniswe ngokuthi "i-EBUS enkulu" yokubheka izilonda ezizungeze imigudu emikhulu yomoya kanye "ne-EBUS encane" (ene-probe engaphandle) yokubheka izilonda zamaphaphu angaphandle. "I-EBUS enkulu" ibonisa ngokusobala ubudlelwano phakathi kwemithambo yegazi, ama-lymph node, kanye nezilonda ezihlala endaweni ngaphakathi kwe-mediastinum ngaphandle kwemigudu yomoya. Iphinde ivumele ukufuthwa kwenaliti ye-transbronchial ngqo esilondeni ngaphansi kokuqapha kwesikhathi sangempela, igweme ngempumelelo ukulimala kwemithambo emikhulu ezungezile kanye nezakhiwo zenhliziyo, ithuthukise ukuphepha nokunemba. "I-EBUS encane" inomzimba omncane, okuvumela ukuthi ibone ngokucacile izilonda zamaphaphu ezingaphandle lapho ama-bronchoscope avamile engakwazi ukufinyelela khona. Uma isetshenziswa ne-introuser sheath, ivumela ukusampula okunembe kakhudlwana.
I-bronchoscopy ye-Fluorescence: I-bronchoscopy ye-immunofluorescence ihlanganisa ama-bronchoscope e-elekthronikhi avamile ne-autofluorescence yamaseli kanye nobuchwepheshe bolwazi ukuhlonza izilonda kusetshenziswa umehluko we-fluorescence phakathi kwamaseli esimila namaseli avamile. Ngaphansi kwamaza athile okukhanya, izilonda ezingaphambi komdlavuza noma izimila zesigaba sokuqala zikhipha i-fluorescence ehlukile ehlukile kumbala wezicubu ezivamile. Lokhu kusiza odokotela ukuthola izilonda ezincane okunzima ukuzibona nge-endoscopy evamile, ngaleyo ndlela kuthuthukiswe izinga lokuxilongwa komdlavuza wamaphaphu kusenesikhathi.
Ama-bronchoscopes amancane kakhulu:Ama-bronchoscope amancane kakhulu ayindlela ye-endoscopic eguquguqukayo enobubanzi obuncane (ngokuvamile <3.0 mm). Asetshenziswa kakhulu ekuhlolweni okunembile noma ekwelapheni izifunda zamaphaphu ezikude. Inzuzo yawo eyinhloko isekhonweni lawo lokubona i-bronchi engaphansi kwesigaba esingaphansi kwezinga lesi-7, okwenza kube nokuhlolwa okuningiliziwe kwezilonda ezincane. Angafinyelela kuma-bronchi amancane okunzima ukuwafinyelela ngama-bronchoscope endabuko, athuthukise izinga lokutholakala kwezilonda zakuqala futhi anciphise ukulimala kokuhlinzwa.Iphayona elisezingeni eliphezulu "ekuzulazuleni + kumarobhothi":ukuhlola "indawo engakaziwa" yamaphaphu.
I-electromagnetic navigation bronchoscopy (ENB) ifana nokuhlomisa i-bronchoscope nge-GPS. Ngaphambi kokuhlinzwa, imodeli yamaphaphu ye-3D iyakhiwa kabusha kusetshenziswa ama-CT scan. Ngesikhathi sokuhlinzwa, ubuchwepheshe bokubeka i-electromagnetic buqondisa i-endoscope emagatsheni ayinkimbinkimbi e-bronchial, buqondise ngqo amaqhubu amancane angaphandle kwamaphaphu anobubanzi obungamamilimitha ambalwa kuphela (njengamaqhubu engilazi engaphansi kuka-5 mm) ukuze kuhlolwe noma kukhishwe igazi.
I-bronchoscopy esizwa yirobhothi: I-endoscope ilawulwa yingalo yerobhothi eqhutshwa udokotela endaweni yokubeka i-console, isusa ithonya lokuthuthumela kwezandla futhi ifinyelele ukunemba okuphezulu kokuma. Ukuphela kwe-endoscope kungajikeleza ama-degree angu-360, okuvumela ukuzulazula okuguquguqukayo ezindleleni ezibuhlungu ze-bronchial. Ifaneleka kakhulu ekuphathweni okunembile ngesikhathi sokuhlinzwa okuyinkimbinkimbi kwamaphaphu futhi isivele ibe nomthelela omkhulu emikhakheni ye-biopsy yamaqhuqhuva amancane emaphashini kanye ne-ablation.
Amanye ama-bronchoscope asekhaya:
Ngaphezu kwalokho, izinhlobo eziningi zasekhaya ezifana ne-Aohua ne-Huaguang nazo zinhle.
Ake sibone ukuthi yini esingayinikeza njengezinto ezisetshenziswayo ze-bronchoscopy
Nazi izinto zethu ezisetshenziswayo ze-endoscopic ezithengiswayo ezihambisana ne-bronchoscopy.
I-Catheter Yokufafaza Elahlwayo
Amabhulashi e-Cytology alahlwayo
I-Biopsy Forceps elahlwayoI-1.8mm biopsy forcepskwe-bronchoscopy engasetshenziswa kabusha
I-1.0mm biopsy forcepskwe-bronchoscopy elahlwayo
Ugibe Lokususwa Kwe-Polypectomy Oluyi-1.8mm
Isikhathi sokuthunyelwe: Septhemba-03-2025