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

Ka hoʻomohala mōʻaukala o ka bronchoscopy

ʻO ka manaʻo ākea o ka bronchoscope pono e komo i ka bronchoscope paʻa a me ka bronchoscope maʻalahi (flexible).

1897

I ka makahiki 1897, ua hana ʻo Gustav Killian ka mea 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 iwi ʻē mai ka trachea o ka mea maʻi.

1904

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

1962

Ua hoʻokumu ke kauka Iapana ʻo Shigeto Ikeda i ka bronchoscope fiberoptic mua. ʻO kēia bronchoscope maʻalahi, microscopic, ana i kekahi mau millimeters wale nō ke anawaena, ua hoʻouna ʻia nā kiʻi ma o nā ʻumi kaukani o nā fiber optical, e hiki ai ke hoʻokomo maʻalahi i loko o ka bronchi segmental a me ka subsegmental bronchi. ʻO kēia holomua i hiki i nā kauka ke nānā pono i nā hale i loko o ka māmā no ka manawa mua, a hiki i nā poʻe maʻi ke ʻae i ka hoʻokolokolo ma lalo o ka anesthesia kūloko, me ka hoʻopau ʻana i ka pono o ka maʻi āpau. ʻO ka hiki ʻana mai o ka fiberoptic bronchoscope i hoʻololi i ka bronchoscopy mai kahi kaʻina hana invasive i kahi hoʻokolokolo liʻiliʻi loa, e hoʻomaʻamaʻa i ka ʻike mua ʻana o nā maʻi e like me ka maʻi kanesa a me ka maʻi maʻi.

1966

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

Fiberoptic bronchoscope:

Olympus XP60, ka anawaena o waho 2.8mm, kaila biopsy 1.2mm

bronchoscope huipu:

Olympus XP260, ka anawaena o waho 2.8mm, kaila biopsy 1.2mm

Ka mōʻaukala o ka pediatric bronchoscopy ma Kina

Ua hoʻomaka ka hoʻohana ʻana o ka bronchoscopy fiberoptic 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. Kūkulu ʻia ma luna o kēia kumu, i ka makahiki 1990 (i hoʻokumu ʻia i ka makahiki 1991), ʻo Professor Liu Xicheng, ma lalo o ke alakaʻi ʻana a Professor Jiang Zaifang, ua hoʻokumu ʻo Kina i ka lumi bronchoscopy pediatric mua loa ma Beijing Children's Hospital i hui pū ʻia me Capital Medical University, e hōʻailona ana i ka hoʻokumu ʻana o ka ʻenehana ʻenehana pediatric bronchoscopy. ʻO ka hoʻokolokolo bronchoscopy fiberoptic mua i loko o kahi keiki ua hana ʻia e ka Respiratory Department ma ka Children's Hospital i hui pū ʻia me Zhejiang University School of Medicine ma 1999, e lilo ana ia i kekahi o nā keʻena mua ma Kina e hoʻokō systematically i nā hoʻokolokolo bronchoscopy fiberoptic a me nā lāʻau lapaʻau i nā pediatrics.

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

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

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

ʻO nā ʻano Bronchoscope ka mea nui i nā bronchoscopes fiberoptic, nā bronchoscopes uila, a me nā bronchoscopes hui. Nui nā hōʻailona kūloko hou ma ka mākeke, ʻo ka nui o ia mau mea he kiʻekiʻe kiʻekiʻe. ʻO kā mākou pahuhopu ka loaʻa ʻana o ke kino ʻoi aku ka ʻoi aku ka ʻoi aku o ka ʻoi aku o ke kino, ʻoi aku ka nui o nā kaha, a me nā kiʻi ʻoi aku ka maopopo.

Hoʻokomo ʻia kekahi mau bronchoscope maʻalahi:

Koho Ana Hoʻohālike:

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

He kūpono no nā hui makahiki āpau (me nā neonates). Loaʻa i kēia manawa ma ka mākeke nā bronchoscopes me nā anawaena o 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 ka 1mm diameter pre-dilating section a me nā stents metala.

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

ʻO ke kumu, kūpono kēia i nā keiki ma mua o hoʻokahi makahiki. ʻO kāna kaila hana 2.0 mm e hiki ai i nā kaʻina hana e like me ka electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), baluna dilatation, a me ka stent placement.

ʻO ka Olympus BF-MP290F he bronchoscope me ke anawaena o waho o 3.5 mm a me kahi kahawai 1.7 mm. ʻO ke anawaena o waho: 3.0 mm ('āpana hoʻokomo ≈ 3.5 mm); Kanal i loko anawaena: 1.7 mm. Hāʻawi ia i ka hele ʻana o 1.5 mm biopsy forceps, 1.4 mm ultrasound probes, a me 1.0 mm brushes. E hoʻomanaʻo ʻaʻole hiki ke komo i kēia kahawai 2.0 mm anawaena biopsy forceps. Hāʻawi pū nā ʻoihana kūloko e like me Shixin i nā kikoʻī like. Hōʻike ʻia nā bronchoscopes hou aʻe o Fujifilm ʻo EB-530P a me EB-530S moʻo i kahi ākea ultra-thin me ka anawaena o waho o 3.5 mm a me kahi kanal anawaena o loko 1.2 mm. He kūpono lākou no ka nānā ʻana a me ke komo ʻana o nā ʻeha o ka māmā peripheral i nā pae pediatric a me nā pākeke. Ua kūpono lākou me 1.0 mm cytology brushes, 1.1 mm biopsy forceps, a me 1.2 mm nā mea ʻē aʻe.

3. Nā Bronchoscopes me ke anawaena o 4.9 mm a i ʻole:

He kūpono no nā keiki 8 makahiki a ʻoi aku ke kaumaha o 35 kg a ʻoi aʻe. Hiki i ke kaila hana 2.0 mm ke hana e like me ka electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), baluna dilatation, a me ka stent placement. ʻO kekahi mau bronchoscopes he ala hana ʻoi aku ka nui ma mua o 2 mm, e ʻoi aku ka maʻalahi o nā kaʻina hana.

Anawaena

4. Nā Kūlana Kūikawā: ʻO nā bronchoscopes ultrathin me ke anawaena o waho o 2.0 mm a i ʻole 2.2 mm a ʻaʻole hiki ke hoʻohana ʻia ke ala hana no ka nānā ʻana i nā alaloa liʻiliʻi liʻiliʻi o nā pēpē i hānau mua a piha paha. He kūpono nō hoʻi ia no ka hoʻokolokolo ʻana i ke ea i nā kamaliʻi ʻōpio me ka stenosis ea koʻikoʻi.

I ka pōkole, pono ke koho ʻia ke kumu hoʻohālike kūpono e pili ana i ka makahiki o ka mea maʻi, ka nui o ka ea, a me ka diagnostic a me ka mālama ʻana e hōʻoia i ka holomua a me ka palekana.

ʻO kekahi mau mea e nānā i ke koho ʻana i kahi aniani:

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

No nā keiki 3-5 makahiki a me ke kaumaha o 15kg-20kg, 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 ʻia ke kiʻi ʻana he wahi nui o ka atelektasis a me ka sputum plug e pāpā ʻia, pono e hoʻohana i ke aniani me ke anawaena o waho o 4.2mm ma mua, ʻoi aku ka ikaika o ka huki a hiki ke omo. Ma hope, hiki ke hoʻohana ʻia kahi aniani aniani 3.0mm no ka ʻeli hohonu a me ka ʻimi ʻana. Inā noʻonoʻo ʻia ʻo PCD, PBB, a me nā mea ʻē aʻe, a hiki i nā keiki ke maʻalahi i ka nui o nā huna huna purulent, pono ʻia e koho i kahi aniani mānoanoa me ke anawaena o waho o 4.2mm, kahi maʻalahi e huki. Eia kekahi, hiki ke hoʻohana ʻia ke aniani me ke anawaena o waho o 3.5mm.

No nā keiki he 5 makahiki a keu paha a he 20 kg a ʻoi aʻe paha, ʻoi aku ka maikaʻi o ka bronchoscope o waho 4.2 mm. ʻO kahi kaha 2.0 mm forceps e hoʻomaʻamaʻa i ka manipulation a me ka hoʻoheheʻe ʻana.

Eia nō naʻe, pono e koho ʻia kahi bronchoscope ʻoi aku ka lahilahi o waho 2.8/3.0 mm i kēia mau kūlana:

① Anatomical airway stenosis:

• ʻO ka maʻi maʻi a i ʻole ka maʻi ma hope o ka hana ʻana, ka tracheobronchomalacia, a i ʻole ka stenosis compression extrinsic. • ʻO ke anawaena o loko o ka māhele bronchial subglottic a haiki loa < 5 mm.

② ʻO ka ʻeha a i ʻole ka edema

• Mahope o ka intubation glottic/subglottic edema, endotracheal kuni, a i ole inhalation eha.

③ ʻO ka stridor koʻikoʻi a i ʻole ka ʻeha hanu

• Laryngotracheobronchitis koʻikoʻi a i ʻole ke kūlana asthmaticus koʻikoʻi me ka liʻiliʻi o ka huhū.

④ Ala ihu me nā puka ihu haiki

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

⑤ Pono e komo i ka bronchus peripheral (papa 8 a i ʻole).
• I kekahi mau hihia o Mycoplasma pneumonia koʻikoʻi me ka atelectasis, inā ʻaʻole hiki ke hoʻihoʻi hou i ka atelectasis nā bronchoscopic alveolar lavages he nui i ka manawa acute, pono paha kahi endoscope maikaʻi e wili hohonu i loko o ka bronchoscope distal e ʻimi a mālama i nā plugs sputum liʻiliʻi. • I nā hihia i manaʻo ʻia o ka ʻaʻai ʻana o ka bronchial (BOB), kahi hopena o ka maʻi pneumonia koʻikoʻi, hiki ke hoʻohana ʻia kahi endoscope maikaʻi no ka wili hohonu ʻana i loko o nā lālā a me nā lālā o ka ʻāpana māmā i hoʻopilikia ʻia. • I nā hihia o ka bronchial atresia congenital, pono ka wili hohonu me ka endoscope maikaʻi no ka bronchial atresia hohonu. • Eia hou, pono kekahi mau ma'i ma'i āpau (e like me ka diffuse alveolar hemorrhage a me peripheral nodules) e pono ai ka endoscope.

⑥ ʻO nā hemahema o ka ʻōpū a i ʻole maxillofacial

• Nā maʻi maʻi Micromandibular a i ʻole craniofacial (e like me Pierre-Robin syndrome) e kaohi ana i ka wahi oropharyngeal.

⑦ ʻO ka manawa kaʻina hana pōkole, pono wale ka hoʻokolokolo diagnostic

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

⑧ Ka hahai ʻana ma hope o ka ʻoihana

• ʻO ka bronchoscopy paʻa hou a i ʻole ka hoʻonui ʻana i ka baluna e hōʻemi i ka ʻeha mucosal lua.

I ka pōkole:

"Stenosis, edema, pōkole o ka hanu, liʻiliʻi nares, hohonu periphery, deformity, pōkole manawa hoʻokolokolo, a me ka hoʻihoʻi ʻana ma hope o ka hana"—inā loaʻa kekahi o kēia mau kūlana, e hoʻololi i kahi endoscope lahilahi 2.8-3.0 mm.

4. No nā keiki i piha i ka 8 makahiki a me ke kaumaha > 35 kg, hiki ke koho ʻia kahi endoscope me ke anawaena o waho o 4.9 mm a ʻoi aku paha. Eia nō naʻe, no ka bronchoscopy maʻamau, ʻoi aku ka liʻiliʻi o ka endoscopes thinner i ka mea maʻi a hoʻemi i ka pilikia o nā pilikia ke ʻole e koi ʻia ka hana kūikawā.

5. ʻO ke kumu hoʻohālike pediatric EBUS mua o Fujifilm ka EB-530US. Kona kī kiko'ī penei: distal waho anawaena: 6.7 mm, hookomo paipu waho anawaena: 6.3 mm, hana ala: 2.0 mm, hana lōʻihi: 610 mm, a me ka huina lōʻihi: 880 mm. Manaʻo makahiki a me ke kaumaha: Ma muli o ka 6.7 mm distal anawaena o ka endoscope, ua ʻōlelo ʻia no nā keiki he 12 makahiki a ʻoi aʻe a i ʻole ke kaupaona ʻana ma mua o 40 kg.

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

Hoʻomaka i nā ʻano bronchoscopy

Hoʻokaʻawale ʻia nā Bronchoscopes e like me kā lākou hoʻolālā a me nā loina kiʻi i loko o kēia mau ʻāpana:

Nā bronchoscope fiberoptic

Nā bronchoskop uila

Nā bronchoscopes hui ʻia

Nā bronchoscopes autofluorescence

Nā bronchoscopes ultrasound

……

Fiberoptic bronchoscopy:

bronchoscope uila:

bronchoscope huipu:

ʻO nā bronchoscope ʻē aʻe:

Nā bronchoscopes ultrasound (EBUS): Ua ʻike ʻia kahi ʻimi ultrasound i hoʻohui ʻia i ka ʻaoʻao mua o kahi endoscope uila ma ke ʻano he "airway B-ultrasound." Hiki iā ia ke komo i loko o ka paia o ke ea a nānā pono i nā ʻōpū lymph mediastinal, nā kīʻaha koko, a me nā ʻōpū ma waho o ka trachea. He kūpono ia no ka mālama ʻana i nā poʻe maʻi maʻi maʻi maʻi maʻi. Ma o ka ultrasound-guided puncture, hiki ke kiʻi pololei ʻia nā laʻana lymph node mediastinal e hoʻoholo ai inā ua metastasized ka ʻōpū, hiki ke pale aku i ka ʻeha o ka thoracotomy kuʻuna. Hoʻokaʻawale ʻia ʻo EBUS i "EBUS nui" no ka nānā ʻana i nā ʻeha a puni nā ala ea nui a me "EBUS liʻiliʻi" (me kahi noiʻi peripheral) no ka nānā ʻana i nā ʻeha ʻāʻī. Hōʻike maopopo ʻia ka "EBUS nui" i ka pilina ma waena o nā kīʻaha koko, nā lymph nodes, a me nā ʻeha e noho ana i loko o ka mediastinum ma waho o nā alaloa. Hāʻawi ia i ka aspiration transbronchial needle pololei i ka lesion ma lalo o ka nānā ʻana i ka manawa maoli, me ka pale ʻana i ka pōʻino i nā moku nui a me nā hale cardiac, hoʻomaikaʻi i ka palekana a me ka pololei. He kino liʻiliʻi ka "EBUS liʻiliʻi", e ʻae iā ia e ʻike pono i nā ʻeha o ka ʻōpū o ke akea kahi i hiki ʻole ai i nā bronchoscopes maʻamau. Ke hoʻohana ʻia me kahi puʻu hoʻolauna, hiki iā ia ke hoʻohālikelike pololei.

Fluorescence bronchoscopy: Hoʻohui ka Immunofluorescence bronchoscopy i nā bronchoscope uila maʻamau me ka cellular autofluorescence a me ka ʻenehana ʻike e ʻike ai i nā ʻeha me ka hoʻohana ʻana i nā ʻokoʻa fluorescence ma waena o nā pūnaewele maʻamau. Ma lalo o nā lōʻihi nalu o ka māmā, hoʻopuka nā lesions precancerous a i ʻole nā maʻi maʻi mua i kahi fluorescence kūʻokoʻa i ʻokoʻa i ke kala o ka ʻiʻo maʻamau. Kōkua kēia i nā kauka e ʻike i nā liʻi liʻiliʻi i paʻakikī ke ʻike me ka endoscopy maʻamau, a laila e hoʻomaikaʻi ai i ka helu mua o ka maʻi kanesa.

ʻO nā bronchoscopes lahilahi:ʻO nā bronchoscopes ultra-thin kahi ʻenehana endoscopic ʻoi aku ka maʻalahi me kahi anawaena liʻiliʻi (maʻamau <3.0 mm). Hoʻohana nui ʻia lākou no ka nānā pono ʻana a i ʻole ka mālama ʻana i nā ʻāpana māmā ākea. ʻO kā lākou pōmaikaʻi koʻikoʻi i ko lākou hiki ke ʻike i ka bronchi subsegmental ma lalo o ka pae 7, e hiki ai i ka nānā kikoʻī hou aku o nā ʻeha maʻalahi. Hiki iā lākou ke hōʻea i ka bronchi liʻiliʻi i paʻakikī ke loaʻa me nā bronchoskop kuʻuna, e hoʻomaikaʻi i ka wikiwiki o ka ʻike ʻana i nā ʻeha mua a me ka hōʻemi ʻana i ka trauma o ke kaʻina.He paionia ʻokiʻoki i ka "navigation + robotics":ka ʻimi ʻana i ka "ʻāina i ʻike ʻole ʻia" o nā māmā.

ʻO ka bronchoscopy hoʻokele electromagnetic (ENB) ua like ia me ka hoʻolako ʻana i kahi bronchoscope me kahi GPS. Ma mua o ka hana ʻana, kūkulu hou ʻia kahi ʻano māmā 3D me ka hoʻohana ʻana i nā scans CT. I ka wā o ke kaʻa ʻana, alakaʻi ka ʻenehana hoʻonohonoho electromagnetic i ka endoscope ma o nā lālā bronchial paʻakikī, e kuhikuhi pono ana i nā nodule māmā peripheral liʻiliʻi e ana ana he mau millimeters wale nō ke anawaena (e like me nā nodule aniani honua ma lalo o 5 mm) no ka biopsy a i ʻole ablation.

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

ʻO kekahi mau bronchoscopes home: