Amakuru - Nigute ushobora guhitamo indorerwamo ya bronchoscopy y'abana?

Iterambere ryamateka ya bronchoscopy

Igitekerezo cyagutse cya bronchoscope kigomba kuba gikubiyemo bronchoscope ikomeye kandi yoroheje (flexible) bronchoscope.

1897

Mu 1897, Gustav Killian w’umudage w’inzobere mu kuvura indwara zo mu bwoko bwa bronchoscopique mu mateka - yakoresheje endoskopi y’icyuma ikomeye kugira ngo akure umubiri w’amahanga mu magufwa muri trachea y’umurwayi.

1904

Chevalier Jackson muri Amerika akora bronchoscope yambere.

1962

Umuganga wumuyapani Shigeto Ikeda yakoze fibreoptic bronchoscope yambere. Iyi mikorobe yoroheje, microscopique bronchoscope, ipima milimetero nkeya z'umurambararo, yohereje amashusho binyuze mumibiri ibihumbi icumi ya fibre optique, ituma byinjira byoroshye mubice ndetse no mubice bya bronchi. Iri terambere ryatumye abaganga bareba neza imiterere yimbere mu bihaha ku nshuro yabo ya mbere, kandi abarwayi bashoboraga kwihanganira isuzumwa ryatewe na anesthesi yaho, bikuraho anesteziya rusange. Kuza kwa fibreoptic bronchoscope byahinduye bronchoscopi bivuye muburyo butera ihinduka ibizamini byibasiye, byorohereza gusuzuma hakiri kare indwara nka kanseri y'ibihaha n'igituntu.

1966

Muri Nyakanga 1966, Machida yakoze bronchoscope ya mbere ya fibreoptike. Muri Kanama 1966, Olympus nayo yakoze fibre optique ya bronchoscope. Nyuma, Pentax na Fuji mu Buyapani, na Wolf mu Budage, na bo basohoye bronchoscopes zabo.

Fiberoptic bronchoscope:

Olympus XP60, diameter yo hanze 2.8mm, umuyoboro wa biopsy 1.2mm

Bronchoscope ivanze:

Olympus XP260, diameter yo hanze 2.8mm, umuyoboro wa biopsy 1.2mm

Amateka ya bronchoscopi y'abana mubushinwa

Gukoresha ivuriro rya fibreoptic bronchoscopy mu bana bo mu gihugu cyanjye byatangiye mu 1985, bikozwe n’ibitaro by’abana i Beijing, Guangzhou, Tianjin, Shanghai, na Dalian. Yubatse kuri uru rufatiro, mu 1990 (yashinzwe ku mugaragaro mu 1991), Porofeseri Liu Xicheng, ayobowe na Porofeseri Jiang Zaifang, yashinze icyumba cya mbere cy’abana cy’abana cy’ubuvuzi cy’abana mu bitaro by’abana ba Beijing gishamikiye kuri kaminuza y’ubuvuzi ya Capital, ibyo bikaba byarashyizweho ku mugaragaro na sisitemu y’ikoranabuhanga ry’abana mu Bushinwa. Ikizamini cya mbere cya fibreoptic bronchoscopy ku mwana cyakozwe n’ishami ry’ubuhumekero mu bitaro by’abana bishamikiye ku ishuri ry’ubuvuzi rya kaminuza ya Zhejiang mu 1999, bituma kiba kimwe mu bigo bya mbere mu Bushinwa byashyize mu bikorwa gahunda y’ibizamini bya fibre optique no kuvura mu buvuzi bw’abana.

Diameter ya tracheal yabana kumyaka itandukanye

Nigute ushobora guhitamo moderi zitandukanye za bronchoscopes?

Guhitamo icyitegererezo cya bronchoscope cyabana bigomba kugenwa ukurikije imyaka umurwayi afite, ingano yumuyaga, hamwe nogusuzuma no kuvura. "Amabwiriza agenga abana Flexible Bronchoscopy mu Bushinwa (Edition Edition 2018)" hamwe nibikoresho bifitanye isano nibyo byibanze.

Ubwoko bwa Bronchoscope burimo cyane cyane fibreoptic bronchoscopes, bronchoscopes electronique, hamwe na bronchoscopes. Hariho ibicuruzwa byinshi bishya byimbere mu gihugu ku isoko, ibyinshi muri byo bifite ubuziranenge. Intego yacu nukugera kumubiri unanutse, imbaraga nini, n'amashusho asobanutse.

Bronchoscopes zimwe zoroshye zihinduka:

Guhitamo Icyitegererezo:

1. Bronchoscopes ifite diameter ya 2.5-3.0mm:

Birakwiriye kumatsinda yose (harimo na neonates). Kugeza ubu kuboneka ku isoko ni bronchoscopes ifite diameter yo hanze ya 2,5mm, 2.8mm, na 3.0mm, hamwe n'umuyoboro wa 1.2mm. Izi bronchoscopes zirashobora gukora ibyifuzo, okisijeni, lavage, biopsy, gukaraba (neza-bristle), kwaguka kwa laser, hamwe no kwaguka kwa ballon hamwe na 1mm ya diameter mbere yo kwaguka hamwe nicyuma.

2. Bronchoscopes ifite diameter ya mm 3,5-4.0:

Mubyukuri, ibi birakwiriye kubana barengeje umwaka. Umuyoboro wacyo wa mm 2,2 utanga uburyo nka electrocoagulation, cryoablation, inshinge za transbronchial aspirasique (TBNA), biopsy ya transbronchial biopsy (TBLB), kwaguka kwa ballon, no gushyira stent.

Olympus BF-MP290F ni bronchoscope ifite diameter yo hanze ya mm 3,5 n'umuyoboro wa mm 1,7. Impanuro yo hanze ya diameter: 3.0 mm (igice cyo gushiramo ≈ 3,5 mm); umuyoboro w'imbere imbere: 1,7 mm. Iremera kunyura kuri 1.5 mm ya biopsy imbaraga, 1,4 mm ultrasound probe, hamwe na 1.0 mm. Menya ko 2.0 mm ya diametre biopsy imbaraga zidashobora kwinjira muriyi nzira. Ibirango byo murugo nka Shixin nabyo bitanga ibisobanuro bisa. Fujifilm izakurikiraho-EB-530P na EB-530S ikurikirana ya bronchoscopes igaragaramo urugero ruto cyane rufite umurambararo wa mm 3,5 na umuyoboro wa diameter 1,2. Birakwiriye kwisuzumisha no gutabara ibihaha bya periferique haba mubana ndetse nabakuze. Zishobora guhuzwa na 1.0 mm ya brush ya cytologiya, 1,1 mm ya biopsy, na 1,2 mm yumubiri wamahanga.

3. Bronchoscopes ifite diameter ya mm 4,9 cyangwa irenga:

Mubisanzwe bikwiranye nabana bafite imyaka 8 nayirenga bafite ibiro 35 cyangwa birenga. Umuyoboro wa mm 2,2 utanga uburyo nka electrocoagulation, cryoablation, inshinge za transbronchial aspiration (TBNA), biopsy y'ibihaha ya transbronchial (TBLB), kwaguka kwa ballon, no gushyira stent. Bronchoscopes zimwe zifite umuyoboro ukora urenze mm 2, bigatuma byoroha muburyo bwo gutabara.

Diameter

4. Birakwiye kandi kwisuzumisha mumyuka kubana bato bafite stenosis ikabije.

Muri make, icyitegererezo gikwiye kigomba gutoranywa ukurikije imyaka umurwayi afite, ingano yumuyaga, hamwe no gusuzuma no kuvura kugirango habeho inzira nziza kandi itekanye.

Ibintu bimwe ugomba kwitondera muguhitamo indorerwamo:

Nubwo 4.0mm ya diametre yo hanze ya bronchoscopes ikwiriye kubana barengeje umwaka 1, mubikorwa nyirizina, 4.0mm ya diameter yo hanze ya bronchoscopes biragoye kugera kumurongo wimbitse wa bronchial wabana bafite imyaka 1-2. Kubwibyo, kubana bari munsi yimyaka 1, 1-2 ans, kandi ipima munsi ya 15kg, inanutse ya 2.8mm cyangwa 3.0mm ya diameter ya bronchoscopes ikoreshwa mubikorwa bisanzwe.

Ku bana bafite imyaka 3-5 kandi ipima 15kg-20kg, urashobora guhitamo indorerwamo yoroheje ifite diameter yo hanze ya 3.0mm cyangwa indorerwamo ifite diameter yo hanze ya 4.2mm. Niba amashusho yerekana ko hari ahantu hanini ya atelectasis na pompe ya sputum ishobora guhagarikwa, birasabwa gukoresha indorerwamo ifite diameter yo hanze ya 4.2mm ubanza, ifite imbaraga zikomeye kandi zishobora gukururwa. Nyuma, indorerwamo ya 3.0mm irashobora gukoreshwa mugucukura cyane no gushakisha. Niba PCD, PBB, nibindi bisuzumwe, kandi abana bakunze kwibasirwa nubwinshi bwimyanya myibarukiro, birasabwa kandi guhitamo indorerwamo yijimye ifite diameter yo hanze ya 4.2mm, byoroshye gukurura. Byongeye, indorerwamo ifite diameter yo hanze ya 3.5mm nayo irashobora gukoreshwa.

Ku bana bafite imyaka 5 cyangwa irenga kandi ipima ibiro 20 cyangwa birenga, muri rusange bronchoscope ya mm 4.2 ya diameter. Umuyoboro wa mm mm 2.0 worohereza manipulation no guswera.

Nyamara, inanutse ya 2.8 / 3.0 mm ya diameter yo hanze ya bronchoscope igomba guhitamo mubihe bikurikira:

En Anatomical airway stenosis:

• Kuvuka cyangwa nyuma yubuvuzi bwa stenosis, tracheobronchomalacia, cyangwa compression stenosis. • Diameter y'imbere ya subglottic cyangwa igufi igice cya bronchial <5 mm.

Tra Ihahamuka rya vuba cyangwa guhungabana

• Indwara ya post-intubation glottic / subglottic edema, gutwika endotracheal, cyangwa gukomeretsa.

Str Inzira ikomeye cyangwa ibibazo byubuhumekero

• Indwara ikaze ya laryngotracheobronchitis cyangwa imiterere ikomeye ya asthmaticus isaba uburakari buke.

Route Inzira izuru hamwe no gufungura amazuru

• Stenosis igaragara ya vestibule yizuru cyangwa turbinite yo hasi mugihe cyo kwinjiza amazuru, bikabuza kunyura muri endoskopi ya mm 4.2 nta gukomeretsa.

Ibisabwa kwinjira muri bronchus ya peripheri (icyiciro cya 8 cyangwa kirenga).
• Rimwe na rimwe usanga umusonga wa Mycoplasma ukabije hamwe na atelectasis, niba imiyoboro myinshi ya alveolar ya bronchoscopique mu cyiciro gikaze ikananirwa kugarura atelectasis, hashobora gukenerwa endoskopi nziza kugira ngo icukure cyane muri bronchoscope ya kure kugira ngo ishakishe kandi ivure uduce duto duto cyane. • Mugihe gikekwa kuba inzitizi ziterwa na bronchial (BOB), urukurikirane rwumusonga ukabije, endoskopi nziza irashobora gukoreshwa kugirango icukure cyane mumashami no munsi yishami ryibihaha byanduye. • Mugihe cya atresia yavutse, gucukura cyane hamwe na endoskopi nziza nabyo birakenewe kuri atresia yimbitse. • Byongeye kandi, bimwe bikwirakwiza ibikomere bya periferique (nka diffuse alveolar hemorhage na nodules ya periferique) bisaba endoskopi nziza.

⑥ Guhuza inkondo y'umura cyangwa ubumuga bwa maxillofacial

• Syndromes ya Micromandibular cyangwa craniofacial (nka syndrome ya Pierre-Robin) igabanya umwanya wa oropharyngeal.

Time Igihe gito cyo gutangira, bisaba gusa kwisuzumisha

• BAL gusa, gukaraba, cyangwa biopsy yoroshye; nta bikoresho binini bisabwa, kandi endoscope yoroheje irashobora kugabanya uburakari.

Gukurikirana nyuma yo kubagwa

• Bronchoscopy ya vuba cyangwa kwaguka kwa ballon kugirango ugabanye ihungabana rya kabiri.

Muri make:

"Stenosis, edema, guhumeka neza, nares nto, peripheri yimbitse, ubumuga, igihe gito cyo kwisuzumisha, no gukira nyuma yo kubagwa" - niba hari kimwe muri ibyo bihe gihari, hindukira kuri endoskopi ya mm 2.8-3.0.

4. Kubana bafite imyaka> 8 nuburemere> 35 kg, hashobora gutorwa endoscope ifite diameter yo hanze ya mm 4,9 cyangwa irenga. Nyamara, kuri bronchoscopi isanzwe, endoskopi yoroheje ntabwo irakaza umurwayi kandi bikagabanya ibyago byo guhura nibibazo keretse bibaye ngombwa ko habaho ubufasha bwihariye.

5. Ubwoko bwa Fujifilm bwibanze bwabana bato EBUS ni EB-530US. Ibisobanuro byingenzi byingenzi ni ibi bikurikira: diameter yo hanze: 6.7 mm, insimburangingo yo hanze ya diametre: 6.3 mm, umuyoboro ukora: mm 2.0, uburebure bwakazi: mm 610, n'uburebure bwose: 880 mm. Basabwa imyaka nuburemere: Bitewe na mm 6,7 mm ya diametre ya endoscope, birasabwa kubana bafite imyaka 12 nayirenga cyangwa ipima> 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Umurongo EBUS (BF-UC190F): ≥ imyaka 12, kg 40. . kubana bato, ibipimo bya probe na mirror bigomba kurushaho kugabanuka.

Intangiriro kuri bronchoscopy zitandukanye

Bronchoscopes ishyirwa muburyo ukurikije imiterere n'amahame yo gufata amashusho mubyiciro bikurikira:

Fiberoptic bronchoscopes

Bronchoscopes ya elegitoroniki

Bronchoscopes ihuriweho

Autofluorescence bronchoscopes

Ultrasound bronchoscopes

……

Fiberoptic bronchoscopy:

Bronchoscope ya elegitoroniki:

Bronchoscope ivanze:

Izindi bronchoscopes:

Ultrasound bronchoscopes (EBUS): Ubushakashatsi bwa ultrasound bwinjijwe mu mpera yimbere ya endoskopi ya elegitoronike izwi nka "inzira yo mu kirere B-ultrasound." Irashobora kwinjira mu rukuta rw'umuyaga kandi ikagaragaza neza imisemburo ya lymph mediastinal, imiyoboro y'amaraso, n'ibibyimba hanze ya trachea. Irakwiriye cyane cyane gutegura abarwayi ba kanseri y'ibihaha. Binyuze mu gutobora ultrasound, urugero rwa lymph node ya mediastinal irashobora kuboneka neza kugirango hamenyekane niba ikibyimba cyarahindutse, gishobora kwirinda ihahamuka rya thoracotomy gakondo. EBUS igabanijwemo "EBUS nini" yo kureba ibikomere bikikije inzira nini na "EBUS nto" (hamwe na probe periferique) yo kureba ibihaha bya periferique. "EBUS nini" yerekana neza isano iri hagati yimiyoboro yamaraso, node ya lymph, hamwe nindwara zifata umwanya muri mediastinum hanze yumuyaga. Iremera kandi ibyifuzo byinshinge za transbronchial muri lesion mugihe gikurikiranwa mugihe nyacyo, birinda neza kwangirika kwamato manini akikije imiterere yumutima, kunoza umutekano nukuri. "EBUS nto" ifite umubiri muto, uyemerera kubona neza ibikomere byo mu bihaha bya periferique aho bronchoscopes isanzwe idashobora kugera. Iyo ikoreshejwe hamwe nintangiriro yintangiriro, itanga ibisobanuro birambuye.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopi ihuza bronchoscopes isanzwe ya elegitoronike hamwe na selile autofluorescence hamwe nikoranabuhanga ryamakuru kugirango hamenyekane ibikomere ukoresheje itandukaniro rya fluorescence hagati ya selile yibibyimba na selile zisanzwe. Munsi yumurambararo wumucyo, ibisebe byabanjirije cyangwa ibibyimba byo hambere bisohora fluorescence idasanzwe itandukanye nibara ryumubiri usanzwe. Ibi bifasha abaganga gutahura ibikomere bito bigoye kumenya hamwe na endoskopi isanzwe, bityo bikazamura igipimo cyo gusuzuma hakiri kare kanseri y'ibihaha.

Ultra-thin bronchoscopes:Ultra-thin bronchoscopes nubuhanga bworoshye bwa endoskopique ifite diameter ntoya (mubisanzwe <3.0 mm). Zikoreshwa cyane cyane mugusuzuma neza cyangwa kuvura uturere twa kure. Inyungu zabo zingenzi ziri mubushobozi bwabo bwo kwiyumvisha ibice bya bronchi munsi yurwego rwa 7, bigafasha gusuzuma birambuye ibikomere byoroshye. Bashobora kugera kuri bronchi nto bigoye kuhagera hamwe na bronchoscopes gakondo, kuzamura igipimo cyo gutahura ibikomere hakiri kare no kugabanya ihungabana ryo kubaga.Umupayiniya wambere muri "navigation + robotics":gushakisha "ifasi itagabanijwe" y'ibihaha.

Electromagnetic yogukoresha bronchoscopy (ENB) ninkuguha bronchoscope na GPS. Mbere yo gutangira, moderi ya 3D y'ibihaha yongeye kubakwa hifashishijwe CT scan. Mugihe cyo kubagwa, tekinoroji ya electromagnetique iyobora endoskopi ikoresheje amashami akomeye ya bronchial, yibanda cyane kuri nodules ntoya ya peripheri yo mu bihaha ipima milimetero nkeya z'umurambararo (nka podiyumu-ibirahuri munsi ya mm 5) kugirango biopsy cyangwa abll.

Bronchoscopi ifashwa na robo: Endoscope iyobowe nububoko bwa robo bukoreshwa na muganga kuri kanseri, bikuraho ingaruka ziterwa no guhinda umushyitsi no kugera kumyanya ihanitse. Impera ya endoscope irashobora kuzenguruka dogere 360, ikemerera kugendagenda byoroshye binyuze mumihanda ya bronchial. Birakwiriye cyane cyane gukoreshwa neza mugihe cyo kubaga ibihaha bigoye kandi bimaze kugira uruhare runini mubijyanye na biopsy ntoya y'ibihaha no gukuraho.

Bronchoscopes zimwe murugo: