Iterambere ry'amateka rya bronchoscopy
Igitekerezo cyagutse cya bronchoscope kigomba kuba kirimo bronchoscope ihamye na bronchoscope ihindagurika (ihindagurika).
1897
Mu 1897, umuganga w’umudage witwa Gustav Killian yakoze igikorwa cyo kubaga bwa mbere mu mateka hakoreshejwe uburyo bwa "bronchoscopic" - yakoresheje "endoscope" y’icyuma gikomeye kugira ngo akureho umubiri w’umunyamahanga wari ufite amagufwa mu muhogo w’umurwayi.
1904
Chevalier Jackson wo muri Leta Zunze Ubumwe za Amerika ni we wakoze bronchoscope ya mbere.
1962
Umuganga w’Umuyapani witwa Shigeto Ikeda yahimbye bronchoscope ya mbere ya fiberoptic. Iyi bronchoscope yoroshye kandi iciriritse, ifite umurambararo wa milimetero nke gusa, yohererejwe amashusho binyuze mu nsinga z’amatara ibihumbi mirongo, bituma byoroha kuyishyira mu bice by’amatara ndetse no mu bice by’amatara. Iyi ntambwe yatumye abaganga bashobora kureba imiterere y’imbere mu bihaha ku nshuro ya mbere, kandi abarwayi bashoboraga kwihanganira gusuzumwa hifashishijwe anesthesia yo mu gace, bikuraho ikibazo cyo gusinziriza rusange. Kuza kwa bronchoscope ya fiberoptic kwahinduye bronchoscopy kuva ku buryo bwo gusinziriza bujya ku buryo bwo gupimwa buto cyane, byorohereza gusuzuma hakiri kare indwara nka kanseri y’ibihaha n’igituntu.
1966
Muri Nyakanga 1966, Machida yakoze bronchoscope ya mbere nyayo ku isi. Muri Kanama 1966, Olympus nayo yakoze bronchoscope yayo ya mbere ya fiberoptic. Nyuma yaho, Pentax na Fuji mu Buyapani, na Wolf mu Budage, na byo byasohoye bronchoscope zabyo.
Bronchoscope ya Fiberoptique:
Olympus XP60, umurambararo wo hanze wa mm 2.8, umuyoboro wa biopsy wa mm 1.2
Bronchoscope ivanze:
Olympus XP260, umurambararo wo hanze wa 2.8mm, umuyoboro wa biopsy wa 1.2mm
Amateka ya bronchoscopy y'abana mu Bushinwa
Ikoreshwa rya fibreoptic bronchoscopy mu buvuzi ku bana bo mu gihugu cyanjye ryatangiye mu 1985, ritangijwe n'ibitaro by'abana i Beijing, Guangzhou, Tianjin, Shanghai, na Dalian. Muri uyu mushinga, Porofeseri Liu Xicheng, ayobowe na Porofeseri Jiang Zaifang, yashinze icyumba cya mbere cy'ubuvuzi bw'abana mu Bushinwa mu bitaro by'abana bya Beijing bifitanye isano na Kaminuza ya Capital Medical, ari na cyo gihe cy'ishyirwaho ry'ikoranabuhanga ry'ubuvuzi bw'abana mu Bushinwa. Isuzuma rya mbere rya fibreoptic bronchoscopy ku mwana ryakozwe n'Ishami rishinzwe ubuhumekero mu bitaro by'abana bifitanye isano n'Ishuri ry'Ubuganga rya Kaminuza ya Zhejiang mu 1999, bituma riba rimwe mu bigo bya mbere mu Bushinwa byashyize mu bikorwa isuzuma rya fibreoptic bronchoscopy n'ubuvuzi ku bana.
Ingano y'umuyoboro w'amaraso mu bana bari mu kigero cy'imyaka itandukanye
Ni gute wahitamo ubwoko butandukanye bwa bronchoscopes?
Amahitamo y'icyitegererezo cya bronchoscope y'abana agomba kugenwa hashingiwe ku myaka y'umurwayi, ingano y'imiyoboro y'umwuka, n'uburyo bwo gusuzuma no kuvura buteganijwe. "Amabwiriza yo gukoresha uburyo bwo gupima bronchoscope y'abana mu Bushinwa (Igitabo cya 2018)" n'ibindi bikoresho bifitanye isano ni byo by'ingenzi bishingirwaho.
Ubwoko bwa bronchoscope burimo cyane cyane bronchoscope za fiberoptic, bronchoscopes z'ikoranabuhanga, na bronchoscopes zivanze. Hari ubwoko bwinshi bushya bwo mu gihugu ku isoko, bwinshi muri bwo bufite ireme ryo hejuru. Intego yacu ni ukugira umubiri muto, imbaraga nini, n'amashusho asobanutse neza.
Hashyizweho bronchoscope zimwe na zimwe zihindura imiterere y'umubiri:
Guhitamo icyitegererezo:
1. Bronchoscope ifite umurambararo wa mm 2.5-3.0:
Bikwiriye abantu b’ingeri zose (harimo n’abana bato). Ubu ku isoko hari bronchoscope zifite umurambararo wo hanze wa mm 2.5, 2.8, na mm 3.0, kandi zifite umuyoboro wa mm 1.2. Izi bronchoscope zishobora gukora aspiration, ogisijeni, gukaraba, biopsy, koza (fine-bristle), kwaguka kwa laser, no kwaguka kw'ibaluni hamwe n'igice cya mm 1 cya diameter mbere yo kwaguka hamwe na stent z'icyuma.
2. Bronchoscope ifite umurambararo wa mm 3.5-4.0:
Mu buryo bw'imitekerereze, ibi birakwiriye abana barengeje umwaka umwe. Umuyoboro wabyo wa mm 2.0 ukora wemerera uburyo nko gukoresha amashanyarazi, gukaraba, gukamura urushinge rwa transbronchial (TBNA), gupima ibihaha bya transbronchial (TBLB), kwagura balloon, no gushyira stent mu mwanya wayo.
Olympus BF-MP290F ni bronchoscope ifite umurambararo wo hanze wa mm 3.5 n'umuyoboro wa mm 1.7. Umurambararo wo hanze: mm 3.0 (igice cyo gushyiramo ≈ mm 3.5); umurambararo wo imbere: mm 1.7. Yemerera inzira ya forceps ya biopsy ya mm 1.5, probes za ultrasound za mm 1.4, na brushes za mm 1.0. Menya ko forceps ya biopsy ya mm 2.0 idashobora kwinjira muri uyu muyoboro. Ibigo byo mu gihugu nka Shixin nabyo bitanga ibisobanuro bisa. Bronchoscopes za Fujifilm zo mu gisekuru gishya EB-530P na EB-530S zifite scope nto cyane ifite umurambararo wo hanze wa mm 3.5 n'umuyoboro wo imbere wa mm 1.2. Zikwiriye gusuzuma no kwibasira ibihaha byo mu gice cy'imbere haba mu bana no mu bantu bakuru. Zirahuye n'uburoso bwa cytology bwa mm 1.0, forceps ya biopsy ya mm 1.1, na forceps y'umubiri wo hanze ya mm 1.2.
3. Bronchoscope ifite umurambararo wa mm 4.9 cyangwa irenga:
Muri rusange ikwiriye abana bafite imyaka 8 no hejuru y'ibiro 35 cyangwa irenga. Umuyoboro w'amashanyarazi wa 2.0 mm wemerera uburyo bwo gukora nko gukoresha amashanyarazi, gukaraba, gukamura urushinge rw'amaraso mu mitsi (TBNA), gupima ibihaha mu mitsi (TBLB), kwagura imbunda no gushyiramo stent. Bronchoscope zimwe na zimwe zifite umuyoboro w'amashanyarazi urenza mm 2, bigatuma byoroha mu buryo bwo gukora.
Ingano
4. Uduce twihariye: Bronchoscope nto cyane ifite umurambararo wo hanze wa mm 2.0 cyangwa mm 2.2 kandi nta muyoboro ukora ushobora gukoreshwa mu gusuzuma inzira z'ubuhumekero ntoya z'impinja zivutse mbere y'igihe cyangwa iz'igihe cyose. Zirakwiriye kandi gupimwa uburyo bw'ubuhumekero ku bana bato bafite ikibazo gikomeye cyo guhumeka kw'ubuhumekero.
Muri make, uburyo bukwiye bwo kuvura bugomba gutoranywa hashingiwe ku myaka y'umurwayi, ingano y'ubuhumekero bwe, n'ibyo akeneye mu gusuzuma no kuvura kugira ngo uburyo bwo kuvura bugende neza kandi butekanye.
Ibintu bimwe na bimwe ugomba kwitaho mu gihe uhitamo indorerwamo:
Nubwo bronchoscope y'umurambararo w'inyuma wa 4.0mm ikwiriye abana barengeje umwaka 1, mu gihe ikora, bronchoscope y'umurambararo w'inyuma wa 4.0mm iragoye kugera ku rumuri rwinshi rw'ibihaha ku bana bari hagati y'umwaka 1-2. Kubwibyo, ku bana bari munsi y'umwaka 1, umwaka 1-2, kandi bapima ibiro biri munsi ya 15kg, bronchoscope yoroheje ya 2.8mm cyangwa 3.0mm y'umurambararo w'inyuma ikoreshwa mu bikorwa bisanzwe.
Ku bana bafite imyaka 3-5 kandi bapima ibiro 15-20kg, ushobora guhitamo indorerwamo ntoya ifite umurambararo wo hanze wa 3.0mm cyangwa indorerwamo ifite umurambararo wo hanze wa 4.2mm. Niba amashusho agaragaza ko hari ahantu hanini hafite atelectasis kandi hari aho amatembabuzi ashobora kuziba, ni byiza kubanza gukoresha indorerwamo ifite umurambararo wo hanze wa 4.2mm, ifite ubwinshi bukomeye kandi ishobora gukururwa. Nyuma, indorerwamo ntoya ya 3.0mm ishobora gukoreshwa mu gucukura no gushakisha mu buryo bwimbitse. Niba hatekerejwe kuri PCD, PBB, nibindi, kandi abana bakaba bafite ubwinshi bw'amatembabuzi, ni byiza kandi guhitamo indorerwamo nini ifite umurambararo wo hanze wa 4.2mm, byoroshye gukurura. Byongeye kandi, indorerwamo ifite umurambararo wo hanze wa 3.5mm nayo irashobora gukoreshwa.
Ku bana bafite imyaka 5 cyangwa irenga kandi bapima ibiro 20 cyangwa birenga, bronchoscope y'umurambararo w'inyuma wa mm 4.2 ni yo ikunze gukoreshwa cyane. Umuyoboro wa forceps wa mm 2.0 ufasha mu gutunganya no gukurura.
Ariko, bronchoscope yoroheje ifite umurambararo wa mm 3.0 igomba gutoranywa mu bihe bikurikira:
① Uburyo umwuka uhagarara mu buryo bw'umubiri:
• Guhagarika umwuka nyuma yo kubagwa, tracheobronchomalacia, cyangwa guhagarara kw'inyuma y'umuyoboro w'amaraso. • Ingano y'imbere y'igice cy'amagufwa cyangwa igice gito cyane cy'amagufwa kiri munsi ya mm 5.
② Gukomereka mu myanya y'ubuhumekero cyangwa kubyimba biherutse kubaho
• Nyuma yo kwinjira mu muyoboro w'amaraso, gutwika mu nda, cyangwa gukomereka mu guhumeka.
③ Indwara ikomeye cyangwa ubuhumekero bukabije
• Laryngotracheobronchite ikabije cyangwa asima ikomeye isaba uburibwe buke.
④ Inzira y'izuru ifite utuzu duto tw'izuru
• Gucika intege cyane kw'uruti rw'izuru cyangwa inferior turbinate mu gihe cyo gushyira mu mazuru, bikabuza endoscope ya 4.2 mm kunyura nta nkomyi.
⑤ Ibisabwa kugira ngo umuntu agere ku gice cy'imbere cy'umutima (cya 8 cyangwa hejuru).
• Mu bihe bimwe na bimwe by’indwara ikomeye ya Mycoplasma pneumonia hamwe na atelectasis, iyo uburyo bwinshi bwo koga mu maraso mu gihe cy’ihungabana butarabasha gusubiza atelectasis, hashobora gukenerwa endoscope nziza kugira ngo icukure cyane muri bronchoscope yo kure kugira ngo isuzume kandi ivure utubuto duto twimbitse. • Mu bihe bikekwa ko hari ikibazo cyo kuziba kw’imitsi y’uruhago (BOB), igice cya nyuma cya pneumonia ikomeye, endoscope nziza ishobora gukoreshwa mu gucukura cyane mu mashami n’amashami y’ibihaha byangiritse. • Mu bihe by’indwara ya bronchial atresia yo mu gihe cy’amavuko, gucukura cyane hakoreshejwe endoscope nziza nabyo ni ngombwa kuri deep bronchial atresia. • Byongeye kandi, bimwe mu bisebe byo mu mpande (nk’amaraso yo mu maraso n’udusimba two mu mpande) bisaba endoscope nziza kurushaho.
⑥ Ubusembwa bw'inkondo y'umura cyangwa ubumuga bwo mu maso
• Indwara ya micromandibular cyangwa craniofacial syndrome (nk'indwara ya Pierre-Robin syndrome) igabanya umwanya w'amaso.
⑦ Igihe gito cyo gukora, gisaba gusa isuzuma ry'indwara
• BAL, koza amenyo, cyangwa biopsy byoroshye ni byo gusa bikenewe; nta bikoresho binini bikenewe, kandi endoscope ntoya ishobora kugabanya uburibwe.
⑧ Gukurikirana nyuma yo kubagwa
• Kwaguka vuba aha kw'amata cyangwa kwaguka kw'amata mu mucosa kugira ngo bigabanye ubukana bw'amata mu mucosa.
Muri make:
"Stenose, kubyimba, guhumeka nabi, imitsi mito, kuzenguruka mu nkengero z'umubiri, ubusembwa, igihe gito cyo gusuzuma, no gukira nyuma yo kubagwa"—niba hari kimwe muri ibi bibazo, hindura ukoreshe endoscope yoroheje ya 2.8–3.0 mm.
4. Ku bana bafite imyaka iri hejuru ya 8 kandi bapima ibiro biri hejuru ya 35, hashobora gutoranywa endoscope ifite umurambararo wo hanze wa mm 4.9 cyangwa irenga. Ariko, kuri bronchoscopy isanzwe, endoscope ntoya ntirakaza umurwayi cyane kandi igabanya ibyago byo kugira ingorane keretse bibaye ngombwa ko hagira ubwunganizi bwihariye.
5. Uburyo bwa Fujifilm bwo gukoresha EBUS y'abana bugezweho ni EB-530US. Ibisobanuro byayo by'ingenzi ni ibi bikurikira: umurambararo w'inyuma wa kure: mm 6.7, umuyoboro w'imbere wa insertion diameter y'inyuma: mm 6.3, umuyoboro w'akazi: mm 2.0, uburebure bw'akazi: mm 610, n'uburebure bwose: mm 880. Imyaka n'uburemere byasabwe: Bitewe n'umurambararo wa kure wa endoscope wa mm 6.7, isabwa abana bafite imyaka 12 kuzamura cyangwa bapima ibiro biri hejuru ya 40.
Bronchoscope ya Ultrasonic ya Olympus: (1) Linear EBUS (BF-UC190F Series): ≥imyaka 12, ≥40 kg. (2) Indorerwamo ya Radial EBUS + Ultrathin (BF-MP290F Series): ≥imyaka 6, ≥20 kg; ku bana bato, uburebure bwa probe n'umurambararo w'indorerwamo bigomba kugabanuka cyane.
Intangiriro ku buryo butandukanye bwo gupima indwara ya bronchoscopy
Bronchoscopes zishyirwa mu byiciro hakurikijwe imiterere yazo n'amahame yo gufata amashusho mu byiciro bikurikira:
Bronchoscopes ya Fiberoptique
Ibronchoscopes y'ikoranabuhanga
Ibronchoscopes zivanze
Ibronchoscopes za Autofluorescence
Ibronchoscope ya Ultrasound
……
Isuzuma rya Fiberoptike:
Bronchoscope y'ikoranabuhanga:
Bronchoscope ivanze:
Izindi bronchoscopes:
Bronchoscope ya Ultrasound (EBUS): Imashini ipima ultrasound ishyirwa mu gice cy'imbere cya endoscope y'ikoranabuhanga izwi nka "airway B-ultrasound." Ishobora kwinjira mu rukuta rw'umwuka ikabona neza utudomo tw'imitsi yo hagati, imitsi y'amaraso, n'ibibyimba biri hanze y'umuyoboro w'amaraso. Ikwiriye cyane cyane abarwayi ba kanseri y'ibihaha. Binyuze muri ultrasound-gutobora, ingero z'utudomo tw'imitsi yo hagati zishobora kuboneka neza kugira ngo hamenyekane niba ikibyimba cyarahindutse, bishobora kwirinda imvune ya gakondo yo mu gituza. EBUS igabanyijemo "EBUS nini" yo kureba ibibyimba bikikije inzira nini z'umwuka na "EBUS nto" (ifite icyuma gipima peripheral) yo kureba ibibyimba by'ibihaha byo ku ruhande. "EBUS nini" igaragaza neza isano iri hagati y'imitsi y'amaraso, utudomo tw'imitsi, n'ibibyimba biri mu mwanya uri hagati ya mediastinum hanze y'inzira z'umwuka. Ituma kandi urushinge rwa transbronchial rushobora kwinjira mu gisebe mu buryo butaziguye munsi y'igenzura ry'igihe gito, birinda kwangirika kw'imitsi minini ikikije n'imiterere y'umutima, binoza umutekano n'ubuziranenge. "EBUS nto" ifite umubiri muto, bigatuma ibasha kubona neza ibisebe byo mu bihaha aho bronchoscope isanzwe idashobora kugera. Iyo ikoreshejwe hamwe n'icyuma gifasha mu gupima, ituma haboneka ingero nziza.
Ishusho y'urumuri rw'amashanyarazi: Ishusho y'urumuri rw'amashanyarazi ihuza ibishushanyo mbonera by'ikoranabuhanga bisanzwe hamwe n'ishusho y'urumuri rw'uturemangingo hamwe n'ikoranabuhanga mu kumenya ibisebe hakoreshejwe itandukaniro ry'urumuri hagati y'uturemangingo tw'ibibyimba n'uturemangingo dusanzwe. Mu gihe cy'urumuri rwihariye, ibisebe bitaratangira kanseri cyangwa ibibyimba bikiri mu ntangiriro z'ikigero bitanga urumuri rwihariye rutandukanye n'ibara ry'uturemangingo dusanzwe. Ibi bifasha abaganga kubona ibisebe bito bigoye kubona hakoreshejwe isuzuma risanzwe rya endoscope, bityo bikanoza igipimo cyo gusuzuma kanseri y'ibihaha hakiri kare.
Bronchoscopes zoroshye cyane:Bronchoscope zoroshye cyane ni uburyo bworoshye bwo gupima mu buryo bwa endoscopic bufite umurambararo muto (ubusanzwe <3.0 mm). Zikoreshwa cyane cyane mu gusuzuma neza cyangwa kuvura ibice by'ibihaha bya kure. Akamaro kazo gakomeye ni ubushobozi bwazo bwo kubona bronchie yo munsi y'urwego rwa 7, bigatuma zisuzuma neza ibisebe bitagaragara neza. Zishobora kugera kuri bronchie ntoya bigoye kugeraho hakoreshejwe bronchoscope isanzwe, zikongera umuvuduko wo kumenya ibisebe hakiri kare no kugabanya ihungabana ryo kubagwa.Umuhanga mu by'ikoranabuhanga mu "gukoresha ikoranabuhanga rya roboti":gushakisha "akarere katazwi" k'ibihaha.
Uburyo bwo gupima ibihaha hakoreshejwe amashanyarazi (ENB) ni nko gushyira bronchoscope mu gikoresho cya GPS. Mbere yo kubagwa, igishushanyo cy’ibihaha cya 3D gishya gikoreshwa hakoreshejwe CT scans. Mu gihe cyo kubaga, ikoranabuhanga ryo gushyira ibihaha mu mwanya wa electromagnetic riyobora endoscope mu mashami akomeye y’ibihaha, rigamije neza utunyangingo duto tw’ibihaha dufite umurambararo wa milimetero nke gusa (nk’utunyangingo tw’ibirahuri biri munsi ya mm 5) kugira ngo habeho biopsy cyangwa ablation.
Bronchoscopy ifashijwe na Robot: Endoscope igenzurwa n'ukuboko kwa roboti kwa muganga kuri console, bikuraho ingaruka zo gutigita kw'intoki no kugera ku buryo bworoshye bwo gushyiramo. Impera ya endoscope ishobora kuzenguruka dogere 360, bigatuma inzira yoroshye yo kunyura mu nzira z'imitsi. Ikwiriye cyane cyane mu gukora neza mu gihe cyo kubaga ibihaha bigoye kandi imaze kugira ingaruka zikomeye mu bijyanye no gufata no gusohora utudomo duto tw'ibihaha.
Amwe mu mashusho yo mu rugo:
Byongeye kandi, ibicuruzwa byinshi byo mu gihugu nka Aohua na Huaguang nabyo ni byiza.
Reka turebe icyo twatanga nk'ibikoresho byo gukoresha mu gupima amenyo (bronchoscopy)
Dore ibikoresho byacu bigezweho bikoreshwa mu gupima imisemburo ya bronchoscopy.
Katheteri ikoreshwa mu gusukura
Uburoso bwa Cytology bukoreshwa mu gihe runaka
Uburyo bwo gusuzuma indwara ya Biopsy bukoreshwa mu buryo butazwi (forceps)1.8mm forceps za biopsykuri bronchoscopy ishobora kongera gukoreshwa
1.0mm forceps ya biopsygupima hakoreshejwe bronchoscopy
Umutego wo kubaga polypectomy wa 1.8mm
Igihe cyo kohereza: Nzeri-03-2025