Nūhou - Pehea e koho ai i ke aniani no ka bronchoscopy pediatric?

Ka hoʻomohala mōʻaukala o ka bronchoscopy

Pono ka manaʻo ākea o ka bronchoscope e hoʻokomo i ka bronchoscope paʻa a me ka bronchoscope maʻalahi (maʻalahi).

1897

I ka makahiki 1897, ua hana ʻo Gustav Killian, he kauka laryngologist Kelemania, i ke ʻoki bronchoscopic mua loa ma ka mōʻaukala - ua hoʻohana ʻo ia i kahi endoscope metala paʻa e wehe i kahi kino haole iwi mai ka trachea o ka mea maʻi.

1904

Hana ʻo Chevalier Jackson ma ʻAmelika Hui Pū ʻIa i ka bronchoscope mua.

1962

Ua hoʻomohala ke kauka Kepanī ʻo Shigeto Ikeda i ka bronchoscope fiberoptic mua. ʻO kēia bronchoscope microscopic palupalu, he mau milimita wale nō ke anawaena, ua hoʻouna i nā kiʻi ma o nā ʻumi tausani o nā fiber optical, e hiki ai ke hoʻokomo maʻalahi i loko o nā bronchi segmental a me nā subsegmental. Ua ʻae kēia holomua i nā kauka e nānā maka i nā ʻano i loko o nā māmā no ka manawa mua, a hiki i nā mea maʻi ke ʻae i ka hoʻokolokolo ʻana ma lalo o ka anesthesia kūloko, e hoʻopau ana i ka pono no ka anesthesia laulā. ʻO ka hiki ʻana mai o ka bronchoscope fiberoptic i hoʻololi i ka bronchoscopy mai kahi hana invasive i kahi hoʻokolokolo minimally invasive, e hoʻomaʻamaʻa ana i ka ʻike mua ʻana i nā maʻi e like me ke kanesa māmā a me ka maʻi puʻupuʻu.

1966

I Iulai 1966, ua hana ʻo Machida i ka bronchoscope fiberoptic maoli mua loa o ka honua. I ʻAukake 1966, ua hana pū ʻo Olympus i kāna bronchoscope fiberoptic mua. Ma hope mai, ua hoʻokuʻu pū ʻo Pentax lāua ʻo Fuji ma Iapana, a me Wolf ma Kelemānia, i kā lākou mau bronchoscope ponoʻī.

ʻO ka bronchoscope fiberoptic:

ʻO Olympus XP60, ke anawaena waho 2.8mm, ke kahawai biopsy 1.2mm

ʻO ka bronchoscope hui pū ʻia:

ʻO Olympus XP260, ke anawaena waho 2.8mm, ke kahawai biopsy 1.2mm

Ka mōʻaukala o ka bronchoscopy pediatric ma Kina

Ua hoʻomaka ka hoʻohana ʻana o ka fiberoptic bronchoscopy i nā keiki ma koʻu ʻāina i ka makahiki 1985, i hoʻomaka ʻia e nā haukapila o nā keiki ma Beijing, Guangzhou, Tianjin, Shanghai, a me Dalian. Ma ke kūkulu ʻana ma luna o kēia kahua, i ka makahiki 1990 (i hoʻokumu kūhelu ʻia i ka makahiki 1991), ua hoʻokumu ʻo Polofesa Liu Xicheng, ma lalo o ke alakaʻi ʻana a Polofesa Jiang Zaifang, i ka lumi bronchoscopy pediatric mua o Kina ma ka Halemai Kamaliʻi o Beijing e pili ana me ke Kulanui Lapaʻau ʻo Capital, e hōʻailona ana i ka hoʻokumu kūhelu ʻana o ka ʻōnaehana ʻenehana bronchoscopy pediatric o Kina. ʻO ka hoʻokolokolo bronchoscopy fiberoptic mua i kahi keiki i hana ʻia e ka ʻOihana Hanu ma ka Halemai Kamaliʻi e pili ana me ke Kula Lapaʻau o ke Kulanui ʻo Zhejiang i ka makahiki 1999, e lilo ia i hoʻokahi o nā ʻoihana mua ma Kina e hoʻokō pono i nā hoʻokolokolo bronchoscopy fiberoptic a me nā lāʻau lapaʻau i ka pediatrics.

ʻO ke anawaena tracheal o nā keiki ma nā makahiki like ʻole

Pehea e koho ai i nā ʻano like ʻole o nā bronchoscopes?

Pono e hoʻoholo ʻia ke koho ʻana o ke kumu hoʻohālike bronchoscope pediatric ma muli o ka makahiki o ka mea maʻi, ka nui o ke ala ea, a me ka hōʻailona a me ka lāʻau i manaʻo ʻia. ʻO nā "Guidelines for Pediatric Flexible Bronchoscopy in China (2018 Edition)" a me nā mea pili e pili ana i nā kuhikuhi mua.

ʻO nā ʻano Bronchoscope e komo pū ana me nā bronchoscope fiberoptic, nā bronchoscope uila, a me nā bronchoscope hui pū ʻia. Nui nā lama kūloko hou ma ka mākeke, he nui o ia mau mea he kiʻekiʻe ke ʻano. ʻO kā mākou pahuhopu ka hoʻokō ʻana i kahi kino lahilahi, nā forceps nui aʻe, a me nā kiʻi maopopo.

Ua hoʻolauna ʻia kekahi mau bronchoscopes palupalu:

Koho Hoʻohālike:

1. Nā Bronchoscopes me ke anawaena o 2.5-3.0mm:

Kūpono no nā hui makahiki āpau (me nā pēpē hānau hou). Loaʻa i kēia manawa ma ka mākeke nā bronchoscopes me nā anawaena waho o 2.5mm, 2.8mm, a me 3.0mm, a me kahi kahawai hana 1.2mm. Hiki i kēia mau bronchoscopes ke hana i ka aspiration, oxygenation, lavage, biopsy, brushing (fine-bristle), laser dilatation, a me ka balloon dilatation me kahi ʻāpana pre-dilatation 1mm diameter a me nā stents metala.

2. Nā Bronchoscopes me ke anawaena o 3.5-4.0 mm:

Ma ke kumumanaʻo, kūpono kēia no nā keiki ma luna o hoʻokahi makahiki. ʻO kāna kahawai hana 2.0 mm e ʻae ai i nā kaʻina hana e like me ka electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, a me ka stent placement.

ʻO ka Olympus BF-MP290F he bronchoscope me ke anawaena waho o 3.5 mm a me kahi kahawai 1.7 mm. Anawaena waho o ka piko: 3.0 mm (ʻāpana hoʻokomo ≈ 3.5 mm); anawaena o loko o ke kahawai: 1.7 mm. Hiki iā ia ke hele i nā forceps biops 1.5 mm, nā probes ultrasound 1.4 mm, a me nā pulumu 1.0 mm. E hoʻomaopopo ʻaʻole hiki i nā forceps biops 2.0 mm ke komo i kēia kahawai. Hāʻawi pū nā lama kūloko e like me Shixin i nā kikoʻī like. Loaʻa i nā bronchoscopes hanauna hou ʻo Fujifilm ʻo EB-530P a me EB-530S kahi scope lahilahi loa me ke anawaena waho o 3.5 mm a me kahi kahawai anawaena o loko 1.2 mm. He kūpono lākou no ka nānā ʻana a me ke komo ʻana o nā ʻeha māmā peripheral i nā hoʻonohonoho pediatric a me nā pākeke. He kūpono lākou me nā pulumu cytology 1.0 mm, nā forceps biops 1.1 mm, a me nā forceps kino haole 1.2 mm.

3. Nā Bronchoscopes me ke anawaena o 4.9 mm a ʻoi aku paha:

Kūpono maʻamau no nā keiki i piha i 8 mau makahiki a ʻoi aku ke kaumaha he 35 kg a ʻoi aku paha. ʻO ke kahawai hana 2.0 mm e ʻae i nā kaʻina hana e like me ka electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, a me ka stent placement. ʻOi aku ka nui o ke kahawai hana o kekahi mau bronchoscopes ma mua o 2 mm, e ʻoi aku ka maʻalahi no nā kaʻina hana interventional.

Anawaena

4. Nā Hihia Kūikawā: Hiki ke hoʻohana ʻia nā bronchoscopes lahilahi loa me ke anawaena o waho o 2.0 mm a i ʻole 2.2 mm a ʻaʻohe ala hana e nānā i nā ala ea liʻiliʻi distal o nā pēpē hānau mua a piha paha. He kūpono nō hoʻi lākou no nā hoʻokolokolo ala ea i nā pēpē ʻōpio me ka stenosis ala ea koʻikoʻi.

I ka pōkole, pono e koho ʻia ke kumu hoʻohālike kūpono ma muli o ka makahiki o ka mea maʻi, ka nui o ke ala ea, a me nā pono diagnostics a me ka mālama ʻana e hōʻoia i kahi kaʻina hana holomua a palekana hoʻi.

ʻEkolu mau mea e pono ai ke hoʻomaopopo ʻia i ke koho ʻana i kahi aniani:

ʻOiai kūpono nā bronchoscopes anawaena waho 4.0mm no nā keiki ma luna o 1 makahiki, i ka hana maoli ʻana, paʻakikī ke hiki aku i nā bronchoscopes anawaena waho 4.0mm i ka lumen bronchial hohonu o nā keiki 1-2 makahiki. No laila, no nā keiki ma lalo o 1 makahiki, 1-2 makahiki, a ʻoi aku ke kaumaha ma mua o 15kg, hoʻohana pinepine ʻia nā bronchoscopes lahilahi 2.8mm a i ʻole 3.0mm anawaena waho no nā hana maʻamau.

No nā keiki i piha i nā makahiki 3-5 a he 15kg-20kg ke kaumaha, hiki iā ʻoe ke koho i kahi aniani lahilahi me ke anawaena o waho o 3.0mm a i ʻole ke aniani me ke anawaena o waho o 4.2mm. Inā hōʻike ke kiʻi he nui kahi o ka atelectasis a ua ālai ʻia paha ka plug sputum, ua ʻōlelo ʻia e hoʻohana mua i ke aniani me ke anawaena o waho o 4.2mm, nona ka ʻoi aku ka ikaika o ka huki ʻana a hiki ke omo ʻia i waho. Ma hope, hiki ke hoʻohana ʻia ke aniani lahilahi 3.0mm no ka ʻeli hohonu a me ka ʻimi ʻana. Inā noʻonoʻo ʻia ka PCD, PBB, a pēlā aku, a he nui nā mea huna purulent i nā keiki, ua ʻōlelo ʻia hoʻi e koho i kahi aniani mānoanoa me ke anawaena o waho o 4.2mm, kahi maʻalahi ke huki. Eia kekahi, hiki ke hoʻohana ʻia ke aniani me ke anawaena o waho o 3.5mm.

No nā keiki i piha i 5 mau makahiki a ʻoi aʻe a he 20 kg a ʻoi paha ke kaumaha, ʻoi aku ka makemake ʻia o kahi bronchoscope me ke anawaena waho he 4.2 mm. Hoʻomaʻalahi kahi kahawai forceps 2.0 mm i ka hoʻoponopono ʻana a me ka omo ʻana.

Eia nō naʻe, pono e koho ʻia kahi bronchoscope lahilahi he 2.8/3.0 mm ke anawaena o waho i nā kūlana aʻe:

① Ke kuhi ʻana o ke alaea anatomical:

• Ka stenosis ea hānau a i ʻole ma hope o ke kaʻina hana, tracheobronchomalacia, a i ʻole ka stenosis compression extrinsic. • Ke anawaena kūloko o ka ʻāpana subglottic a i ʻole ka ʻāpana bronchial haiki loa < 5 mm.

② ʻO ka trauma a i ʻole ka edema o ke alaloa hou

• ʻEdema glottic/subglottic ma hope o ka hoʻokomo ʻana i ka tubule, nā ʻā endotracheal, a i ʻole ka ʻeha hanu ʻana.

③ ʻO ka stridor koʻikoʻi a i ʻole ka pilikia hanu

• ʻO ka laryngotracheobronchitis koʻikoʻi a i ʻole ka asthmaticus koʻikoʻi e pono ai ka hoʻonāukiuki liʻiliʻi.

④ Ala ihu me nā puka ihu haiki

• Ka stenosis koʻikoʻi o ka vestibule ihu a i ʻole ka turbinate lalo i ka wā e hoʻokomo ai i ka ihu, e pale ana i ka hele ʻana o kahi endoscope 4.2 mm me ka ʻeha ʻole.

⑤ Ke koi ʻana e komo i loko o kahi bronchus peripheral (papa 8 a ʻoi aku paha).
• I kekahi mau hihia o ka maʻi pneumonia Mycoplasma koʻikoʻi me ka atelectasis, inā ʻaʻole hiki i nā lavages alveolar bronchoscopic he nui i ka wā koʻikoʻi ke hoʻihoʻi i ka atelectasis, pono paha kahi endoscope maikaʻi e wili hohonu i loko o ka bronchoscope distal e ʻimi a mālama i nā plug sputum liʻiliʻi a hohonu. • I nā hihia i manaʻo ʻia o ka bronchial obstruction (BOB), kahi hopena o ka maʻi pneumonia koʻikoʻi, hiki ke hoʻohana ʻia kahi endoscope maikaʻi e wili hohonu i loko o nā subbranchs a me nā subsubbranches o ka ʻāpana māmā i hoʻopilikia ʻia. • I nā hihia o ka atresia bronchial congenital, pono nō hoʻi ka wili hohonu me kahi endoscope maikaʻi no ka atresia bronchial hohonu. • Eia kekahi, pono kekahi mau ʻeha peripheral diffuse (e like me ka diffuse alveolar hemorrhage a me nā nodules peripheral) i kahi endoscope maikaʻi.

⑥ Nā ʻano kīnā cervical a maxillofacial paha e pili pū ana

• Nā maʻi micromandibular a i ʻole craniofacial (e like me ka maʻi Pierre-Robin) e kaupalena ana i ka hakahaka oropharyngeal.

⑦ Ka manawa hana pōkole, e koi ana i ka hoʻokolokolo diagnostic wale nō

• ʻO BAL wale nō, ka palaki ʻana, a i ʻole ka biopsy maʻalahi e pono ai; ʻaʻohe mea hana nui e pono ai, a hiki i kahi endoscope lahilahi ke hōʻemi i ka huhū.

⑧ Ka hahai ʻana ma hope o ke ʻoki ʻana

• Ka bronchoscopy paʻa a i ʻole ka hoʻonui ʻana o ka balloon i hala koke nei e hōʻemi i ka trauma mucosal lua.

I ka pōkole:

"Stenosis, edema, pōkole o ka hanu, nā ihu liʻiliʻi, ka ʻaoʻao hohonu, ke ʻano ʻē, ka manawa hoʻokolokolo pōkole, a me ka hoʻōla ʻana ma hope o ka hana ʻana"—inā loaʻa kekahi o kēia mau kūlana, e hoʻololi i kahi endoscope lahilahi 2.8–3.0 mm.

4. No nā keiki >8 mau makahiki a ʻoi aku ke kaumaha ma mua o 35 kg, hiki ke koho ʻia kahi endoscope me ke anawaena waho o 4.9 mm a ʻoi aku paha. Eia nō naʻe, no ka bronchoscopy maʻamau, ʻoi aku ka liʻiliʻi o ka hoʻonāukiuki ʻana o nā endoscopes lahilahi i ka mea maʻi a hōʻemi i ka pilikia o nā pilikia ke ʻole e koi ʻia ke komo kūikawā.

5. ʻO ke kumu hoʻohālike EBUS pediatric mua o Fujifilm ʻo ia ka EB-530US. ʻO kāna mau kikoʻī koʻikoʻi penei: ke anawaena waho distal: 6.7 mm, ke anawaena waho o ka paipu hoʻokomo: 6.3 mm, ke kahawai hana: 2.0 mm, ka lōʻihi hana: 610 mm, a me ka lōʻihi holoʻokoʻa: 880 mm. Makahiki a me ke kaumaha i manaʻo ʻia: Ma muli o ke anawaena distal 6.7 mm o ka endoscope, ua ʻōlelo ʻia no nā keiki he 12 mau makahiki a ʻoi aʻe a i ʻole ke kaumaha ma mua o 40 kg.

ʻO Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 mau makahiki, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 mau makahiki, ≥20 kg; no nā keiki ʻōpio, pono e hoʻemi hou ʻia ke anawaena o ka probe a me ke aniani.

Hoʻolauna i nā ʻano bronchoscopy like ʻole

Ua hoʻokaʻawale ʻia nā Bronchoscopes e like me ko lākou ʻano a me nā loina kiʻi i nā ʻano penei:

Nā bronchoscopes fiberoptic

Nā bronchoscopes uila

Nā bronchoscopes i hui pū ʻia

Nā bronchoscopes Autofluorescence

Nā bronchoscopes ultrasound

……

ʻO ka bronchoscopy fiberoptic:

ʻO ka bronchoscope uila:

ʻO ka bronchoscope hui pū ʻia:

Nā bronchoscopes ʻē aʻe:

ʻO nā bronchoscopes Ultrasound (EBUS): ʻO kahi probe ultrasound i hoʻohui ʻia i loko o ka ʻaoʻao mua o kahi endoscope uila ua kapa ʻia ʻo "airway B-ultrasound." Hiki iā ia ke komo i loko o ka paia o ke ala ea a ʻike maopopo i nā node lymph mediastinal, nā kīʻaha koko, a me nā puʻupuʻu ma waho o ka trachea. He kūpono loa ia no ka hoʻonohonoho ʻana i nā maʻi maʻi kanesa māmā. Ma o ka puncture i alakaʻi ʻia e ka ultrasound, hiki ke loaʻa pololei nā laʻana o ka node lymph mediastinal e hoʻoholo ai inā ua metastasized ka puʻupuʻu, e pale aku ana paha i ka trauma o ka thoracotomy kuʻuna. Ua māhele ʻia ʻo EBUS i "EBUS nui" no ka nānā ʻana i nā lesions a puni nā ala ea nui a me "EBUS liʻiliʻi" (me kahi probe peripheral) no ka nānā ʻana i nā lesions peripheral lungs. Hōʻike maopopo ka "EBUS nui" i ka pilina ma waena o nā kīʻaha koko, nā node lymph, a me nā lesions space-occupying i loko o ka mediastinum ma waho o nā ala ea. Hiki nō hoʻi iā ia ke komo pololei i ka nila transbronchial i loko o ka lesion ma lalo o ka nānā ʻana i ka manawa maoli, e pale pono ana i ka hōʻino ʻana i nā kīʻaha koko nui a puni a me nā ʻano cardiac, e hoʻomaikaʻi ana i ka palekana a me ka pololei. He kino liʻiliʻi ko ka "EBUS liʻiliʻi", e hiki ai iā ia ke ʻike maopopo i nā ʻeha māmā peripheral kahi i hiki ʻole ai i nā bronchoscopes maʻamau ke hiki. Ke hoʻohana ʻia me kahi ʻeke hoʻolauna, hiki iā ia ke ʻike pololei i ka laʻana.

ʻO ka bronchoscopy fluorescence: Hoʻohui ka bronchoscopy immunofluorescence i nā bronchoscopes uila maʻamau me ka autofluorescence cellular a me ka ʻenehana ʻike e ʻike i nā lesions me ka hoʻohana ʻana i nā ʻokoʻa fluorescence ma waena o nā cell tumor a me nā cell maʻamau. Ma lalo o nā nalu kikoʻī o ke kukui, hoʻopuka nā lesions precancerous a i ʻole nā tumors mua i kahi fluorescence kū hoʻokahi e ʻokoʻa mai ke kala o nā ʻiʻo maʻamau. Kōkua kēia i nā kauka e ʻike i nā lesions liʻiliʻi i paʻakikī ke ʻike me ka endoscopy maʻamau, no laila e hoʻomaikaʻi ana i ka helu ʻike mua o ka maʻi ʻaʻai māmā.

Nā bronchoscopes lahilahi loa:ʻO nā bronchoscopes lahilahi loa he ʻano hana endoscopic ʻoi aku ka maʻalahi me ke anawaena liʻiliʻi (maʻamau <3.0 mm). Hoʻohana nui ʻia lākou no ka hoʻokolokolo pololei a i ʻole ka mālama ʻana i nā ʻāpana māmā distal. ʻO ko lākou pono nui aia i ko lākou hiki ke ʻike i nā bronchi subsegmental ma lalo o ka pae 7, e hiki ai ke hoʻokolokolo kikoʻī i nā ʻeha maalea. Hiki iā lākou ke hōʻea i nā bronchi liʻiliʻi i paʻakikī ke hiki aku me nā bronchoscopes kuʻuna, e hoʻomaikaʻi ana i ka helu ʻike o nā ʻeha mua a me ka hōʻemi ʻana i ka trauma ʻoki.He paionia ʻoi loa i ka "hoʻokele + robotics":ke ʻimi nei i ka "ʻāina i palapala ʻole ʻia" o nā māmā.

Ua like ka electromagnetic navigation bronchoscopy (ENB) me ka hoʻolako ʻana i kahi bronchoscope me kahi GPS. Ma mua o ke ʻoki ʻana, ua hana hou ʻia kahi kumu hoʻohālike māmā 3D me ka hoʻohana ʻana i nā scan CT. I ka wā o ke ʻoki ʻana, alakaʻi ka ʻenehana hoʻonoho electromagnetic i ka endoscope ma o nā lālā bronchial paʻakikī, e kuhikuhi pono ana i nā nodules māmā peripheral liʻiliʻi e ana wale ana i kekahi mau millimeters ke anawaena (e like me nā nodules aniani honua ma lalo o 5 mm) no ka biopsy a i ʻole ka ablation.

ʻO ka bronchoscopy i kōkua ʻia e ka robot: Hoʻokele ʻia ka endoscope e kahi lima robotic i mālama ʻia e ke kauka ma kahi console, e hoʻopau ana i ka mana o nā haʻalulu lima a hoʻokō i ka pololei o ke kūlana kiʻekiʻe. Hiki i ka hopena o ka endoscope ke hoʻohuli i 360 degere, e ʻae ana i ka hoʻokele maʻalahi ma o nā ala bronchial tortuous. He kūpono loa ia no ka hoʻoponopono pololei ʻana i ka wā o nā ʻokiʻoki māmā paʻakikī a ua hana mua i kahi hopena koʻikoʻi ma nā kahua o ka biopsy nodule māmā liʻiliʻi a me ka ablation.

ʻO kekahi mau bronchoscopes kūloko: