Labarai - Yadda ake zaɓar madubi don duban yara?

Ci gaban bronchoscopy a tarihi

Faɗin manufar bronchoscope ya kamata ya haɗa da matsewar bronchoscope da kuma na'urar bronchoscope mai sassauƙa (mai sassauƙa).

1897

A shekarar 1897, wani masanin laryngologist na ƙasar Jamus Gustav Killian ya yi tiyatar bronchoscopic ta farko a tarihi - ya yi amfani da na'urar endoscope ta ƙarfe mai ƙarfi don cire wani ƙashi daga cikin bututun mara lafiya.

1904

Chevalier Jackson a Amurka ne ke ƙera na'urar hangen nesa ta farko.

1962

Likitan kasar Japan Shigeto Ikeda ya ƙirƙiro na'urar bronchoscope ta farko ta fiberoptic. Wannan na'urar bronchoscope mai sassauƙa, mai girman milimita kaɗan a diamita, tana watsa hotuna ta hanyar dubban zare na gani, wanda hakan ya ba da damar saka su cikin na'urar broncho ta sashe-sashe har ma da ta sashe-sashe. Wannan ci gaban ya bai wa likitoci damar kallon gine-gine a cikin huhu a karon farko, kuma marasa lafiya za su iya jure wa gwajin a ƙarƙashin maganin sa barci na gida, wanda hakan ya kawar da buƙatar maganin sa barci na gaba ɗaya. Zuwan na'urar bronchoscope ta fiberoptic ya canza na'urar bronchoscope daga wata hanya mai shiga tsakani zuwa wata hanya mai ƙarancin shiga tsakani, wanda hakan ya sauƙaƙa gano cututtuka kamar cutar kansar huhu da tarin fuka da wuri.

1966

A watan Yulin 1966, Machida ta samar da na'urar hangen nesa ta fiberoptic ta farko a duniya. A watan Agustan 1966, Olympus ta kuma samar da na'urar hangen nesa ta fiberoptic ta farko. Daga baya, Pentax da Fuji a Japan, da Wolf a Jamus, suma sun fitar da nasu na'urar hangen nesa ta bronchoscopes.

Fiberoptic bronchoscopy:

Olympus XP60, diamita na waje 2.8mm, tashar biopsy 1.2mm

Maganin bronchoscope:

Olympus XP260, diamita na waje 2.8mm, tashar biopsy 1.2mm

Tarihin binciken ƙwayoyin cuta na yara a China

Amfani da maganin fibrooptic bronchoscopy na yara a ƙasarmu ya fara ne a shekarar 1985, wanda asibitocin yara a Beijing, Guangzhou, Tianjin, Shanghai, da Dalian suka fara. A kan wannan gidauniya, a shekarar 1990 (wanda aka kafa a hukumance a shekarar 1991), Farfesa Liu Xicheng, ƙarƙashin jagorancin Farfesa Jiang Zaifang, ya kafa ɗakin binciken bronoscope na yara na farko a ƙasar Sin a Asibitin Yara na Beijing wanda ke da alaƙa da Jami'ar Capital Medical, wanda hakan ya nuna kafa tsarin fasahar bronoscopy na yara na ƙasar Sin a hukumance. Sashen Numfashi na Asibitin Yara wanda ke da alaƙa da Makarantar Likitanci ta Jami'ar Zhejiang a shekarar 1999 ne ya gudanar da gwajin bronoscope na farko a cikin yaro, wanda ya sanya shi ɗaya daga cikin cibiyoyi na farko a ƙasar Sin da suka aiwatar da gwaje-gwaje da jiyya na bronoscopy na fiberoptic a fannin kula da yara.

Diamita na trachea na yara a shekaru daban-daban

Yadda ake zaɓar samfuran bronchoscopes daban-daban?

Ya kamata a tantance zaɓin samfurin bronchoscopy na yara dangane da shekarun majiyyaci, girman hanyar numfashi, da kuma ganewar asali da magani da aka yi niyya. "Jagororin don Bronchoscopy mai sassauƙa na yara a China (Bugun 2018)" da kayan da suka shafi su ne manyan abubuwan da aka fi amfani da su.

Nau'ikan Bronchoscopes galibi sun haɗa da fiberoptic bronchoscopes, electronic bronchoscopes, da kuma combination bronchoscopes. Akwai sabbin kayayyaki na cikin gida da yawa a kasuwa, waɗanda da yawa daga cikinsu suna da inganci. Manufarmu ita ce mu sami jiki mai siriri, manyan forceps, da hotuna masu haske.

Ana amfani da wasu hanyoyin bincike na bronchoscopes:

Zaɓin Samfuri:

1. Na'urorin Bronchoscopes masu diamita na 2.5-3.0mm:

Ya dace da duk rukunin shekaru (gami da jarirai). A halin yanzu akwai na'urorin bronchoscopes masu diamita na waje na 2.5mm, 2.8mm, da 3.0mm, kuma suna da hanyar aiki ta 1.2mm. Waɗannan na'urorin bronchoscopes na iya yin aikin buɗaɗɗen iska, sanya iskar oxygen, wankewa, cire ƙwayoyin cuta, gogewa (kyakkyawan bristle), faɗaɗa laser, da faɗaɗa balan-balan tare da sashin da ke da diamita na 1mm da kuma stent na ƙarfe.

2. Na'urorin Bronchoscopes masu diamita na 3.5-4.0 mm:

A ka'ida, wannan ya dace da yara 'yan sama da shekara ɗaya. Tashar aikinta mai tsawon mm 2.0 tana ba da damar yin amfani da hanyoyin kamar su electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), fadada balan-balan, da kuma sanya stent.

Na'urar Olympus BF-MP290F na'urar bronchoscope ce mai diamita na waje na 3.5 mm da kuma tashar 1.7 mm. Diamita na waje na tip: 3.0 mm (sashi na sakawa ≈ 3.5 mm); diamita na ciki na tashar: 1.7 mm. Yana ba da damar wucewar forceps na biopsy na 1.5 mm, gwajin duban dan tayi na 1.4 mm, da goga 1.0 mm. Lura cewa forceps na biopsy na 2.0 mm ba za su iya shiga wannan tashar ba. Kamfanonin cikin gida kamar Shixin suma suna ba da irin wannan takamaiman bayanai. Bronchoscopes na Fujifilm na gaba na EB-530P da EB-530S suna da sirara mai matuƙar siriri tare da diamita na waje na 3.5 mm da tashar diamita na ciki na 1.2 mm. Sun dace da bincike da kuma shiga tsakani na raunukan huhu na gefe a wuraren kula da yara da manya. Sun dace da goga 1.0 mm na cytology, forceps na biops na 1.1 mm, da forceps na jikin waje na 1.2 mm.

3. Na'urorin bincike na bronchoscopes masu diamita na 4.9 mm ko sama da haka:

Gabaɗaya ya dace da yara 'yan shekara 8 zuwa sama da nauyin kilogiram 35 ko fiye. Tashar aiki mai girman mm 2.0 tana ba da damar yin amfani da hanyoyin kamar su electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), fadada balan-balan, da kuma sanya stent. Wasu bronchoscopes suna da hanyar aiki fiye da mm 2, wanda hakan ya sa suka fi dacewa da hanyoyin shiga tsakani.

diamita

4. Lamura na Musamman: Ana iya amfani da na'urorin duba ƙwayoyin cuta masu siriri sosai waɗanda diamita na waje ya kai 2.0 mm ko 2.2 mm kuma babu wata hanyar aiki da za a iya amfani da ita don duba ƙananan hanyoyin numfashi na jarirai waɗanda ba su kai shekara ɗaya ba ko kuma waɗanda ba su kai shekara ɗaya ba. Haka kuma sun dace da gwajin hanyoyin numfashi ga jarirai ƙanana waɗanda ke fama da matsanancin toshewar hanyoyin numfashi.

A takaice dai, ya kamata a zaɓi samfurin da ya dace bisa ga shekarun majiyyaci, girman hanyar numfashi, da buƙatun bincike da magani don tabbatar da nasarar aikin.

Wasu abubuwan da ya kamata a lura da su yayin zabar madubi:

Duk da cewa na'urorin bronchoscope na waje masu diamita 4.0mm sun dace da yara 'yan sama da shekara 1, a zahiri, na'urorin bronchoscope na waje masu diamita 4.0mm suna da wahalar isa ga zurfin lumen na bronchial na yara 'yan shekara 1-2. Saboda haka, ga yara 'yan ƙasa da shekara 1, 'yan shekara 1-2, kuma waɗanda nauyinsu bai wuce kilogiram 15 ba, galibi ana amfani da na'urorin bronchoscope na waje masu diamita 2.8mm ko 3.0mm don ayyukan yau da kullun.

Ga yara 'yan shekara 3-5 kuma suna da nauyin kilogiram 15-20, za ku iya zaɓar madubi siriri mai diamita na waje na 3.0mm ko madubi mai diamita na waje na 4.2mm. Idan hoton ya nuna cewa akwai babban yanki na atelectasis kuma toshewar maniyyi yana iya toshewa, ana ba da shawarar a yi amfani da madubi mai diamita na waje na 4.2mm da farko, wanda ke da jan hankali mafi ƙarfi kuma ana iya tsotse shi. Daga baya, ana iya amfani da madubi siriri na 3.0mm don zurfafa haƙowa da bincike. Idan ana la'akari da PCD, PBB, da sauransu, kuma yara suna da saurin kamuwa da yawan fitar da ruwa daga jiki, ana kuma ba da shawarar a zaɓi madubi mai kauri mai diamita na waje na 4.2mm, wanda yake da sauƙin jawowa. Bugu da ƙari, ana iya amfani da madubi mai diamita na waje na 3.5mm.

Ga yara 'yan shekara 5 ko sama da haka kuma nauyinsu ya kai kilogiram 20 ko sama, galibi ana fifita amfani da na'urar bronchoscope ta waje mai diamita 4.2 mm. Tashar forceps mai tsawon mm 2.0 tana sauƙaƙa sarrafa da tsotsa.

Duk da haka, ya kamata a zaɓi siririn bronchoscope na waje mai diamita 2.8/3.0 mm a cikin waɗannan yanayi:

① Tsarin hanyoyin iska na jiki:

• Ciwon hanyoyin iska da aka haifa ko aka yi bayan tiyata, ko kuma ciwon tracheobronchomalacia, ko kuma ciwon matsewar waje. • Diamita na ciki na ɓangaren bronchial mai ƙanƙanta ko mafi ƙanƙanta < 5 mm.

② Raunin numfashi ko kumburi kwanan nan

• Kumburin glottic/subglottic bayan shigar ciki, ƙonewar endotracheal, ko rauni a numfashi.

③ Matsanancin ciwon zuciya ko matsalar numfashi

• Ciwon laryngotracheobronchitis mai tsanani ko kuma asma mai tsanani wanda ke buƙatar ɗan ƙanƙantar da hankali.

④ Hanyar hanci mai ƙunci da buɗewar hanci

• Babban toshewar hanci ko kuma turbinate na ƙasa yayin saka hanci, wanda ke hana wucewar endoscope mai tsawon mm 4.2 ba tare da wani rauni ba.

⑤ Bukatar shiga cikin mashin na gefe (sashe na 8 ko sama da haka).
• A wasu lokuta na ciwon huhu mai tsanani na Mycoplasma tare da atelectasis, idan wankewar alveolar da yawa a cikin yanayin gaggawa har yanzu bai dawo da atelectasis ba, ana iya buƙatar ƙaramin endoscope don haƙa zurfin cikin bronchoscope na nesa don bincika da kuma magance ƙananan matosai masu zurfi na maniyyi. • A cikin abubuwan da ake zargi na toshewar bronchial (BOB), sakamakon ciwon huhu mai tsanani, ana iya amfani da ƙaramin endoscope don haƙa zurfin cikin ƙananan rassan da ƙananan rassan sashin huhu da abin ya shafa. • A cikin lokuta na atresia na bronchial na haihuwa, haƙa zurfin tare da ƙaramin endoscope shima yana da mahimmanci don atresia mai zurfi na bronchial. • Bugu da ƙari, wasu raunuka na gefe (kamar zubar jini na alveolar da nodules na gefe) suna buƙatar mafi kyawun endoscope.

⑥ Nakasar mahaifa ko ta fuska mai haɗuwa

• Ciwon Micromandibular ko craniofacial syndromes (kamar ciwon Pierre-Robin) wanda ke takaita sararin oropharyngeal.

⑦ Lokacin aiki na ɗan gajeren lokaci, wanda ke buƙatar gwajin ganewar asali kawai

• Ana buƙatar BAL, goge baki, ko kuma biopsy mai sauƙi kawai; ba a buƙatar manyan kayan aiki, kuma siririn endoscope na iya rage ƙaiƙayi.

⑧ Binciken bayan tiyata

• An yi gwajin bronchoscopy mai ƙarfi ko faɗaɗa balan-balan kwanan nan don rage raunin da ke tattare da mucosa.

A takaice:

"Ƙwayar jijiya, kumburi, ƙarancin numfashi, ƙananan maƙogwaro, zurfin gefe, nakasar jiki, ɗan gajeren lokacin gwaji, da kuma murmurewa bayan tiyata" - idan akwai ɗaya daga cikin waɗannan yanayi, canza zuwa na'urar endoscope mai sirara ta 2.8–3.0 mm.

4. Ga yara 'yan sama da shekaru 8 kuma nauyinsu ya wuce kilogiram 35, ana iya zaɓar na'urar endoscope mai diamita na waje na mm 4.9 ko fiye. Duk da haka, don na'urar bronchoscopy ta yau da kullun, na'urorin endoscope masu siriri ba sa ɓata wa majiyyaci rai kuma suna rage haɗarin rikitarwa sai dai idan an buƙaci sa hannun musamman.

5. Tsarin EBUS na farko na yara na Fujifilm na yanzu shine EB-530US. Manyan bayanai nasa sune kamar haka: diamita na waje na nesa: 6.7 mm, diamita na waje na bututun shigarwa: 6.3 mm, tashar aiki: 2.0 mm, tsawon aiki: 610 mm, da jimlar tsawon: 880 mm. Shekaru da nauyi da aka ba da shawarar: Saboda diamita na nesa na endoscope na 6.7 mm, ana ba da shawarar ga yara 'yan shekara 12 zuwa sama ko kuma waɗanda suka yi nauyi sama da 40 kg.

Na'urar Duban Dutse ta Olympus Ultrasonic: (1) EBUS mai layi (Jerin BF-UC190F): ≥ shekaru 12, ≥ kg 40. (2) Madubin Radial EBUS + Madubin Sirara (Jerin BF-MP290F): ≥ shekaru 6, ≥ kg 20; ga ƙananan yara, ana buƙatar a ƙara rage diamita na na'urar duba da madubi.

Gabatarwa ga nau'ikan bronchoscopy daban-daban

Ana rarraba bronchoscopes bisa ga tsarinsu da ka'idojin daukar hoto zuwa rukuni masu zuwa:

Fiberoptic bronchoscopy

Na'urorin lantarki na bronchoscopes

Haɗaɗɗen bronchoscopes

Na'urar duba haske ta atomatik

Duban dan tayi na bronchoscopes

……

Binciken Fiberoptic Bronchoscopy:

Na'urar duban dan tayi ta lantarki:

Maganin bronchoscope:

Wasu hanyoyin bincike na bronchoscope:

Duban dan tayi na Ultrasound (EBUS): An san na'urar duban dan tayi da aka haɗa a ƙarshen gaba na na'urar endoscope ta lantarki da suna "hanyar iska ta B-ultrasound." Yana iya shiga bangon hanyar iska kuma ya nuna ƙwayoyin lymph na mediastinal, jijiyoyin jini, da ƙari a wajen trachea. Ya dace musamman don duba marasa lafiya da ke fama da cutar kansar huhu. Ta hanyar huda ta hanyar duban dan tayi, ana iya samun samfuran ƙwayoyin lymph na mediastinal daidai don tantance ko ciwon ya bazu, wanda zai iya guje wa raunin da thoracotomy na gargajiya ya haifar. An raba EBUS zuwa "babban EBUS" don lura da raunuka a kusa da manyan hanyoyin iska da "ƙaramin EBUS" (tare da binciken gefe) don lura da raunukan huhu na gefe. "Babban EBUS" yana nuna alaƙar da ke tsakanin tasoshin jini, ƙwayoyin lymph, da raunukan da ke mamaye sararin samaniya a cikin mediastinum a wajen hanyoyin iska. Hakanan yana ba da damar yin allurar transbronchial kai tsaye zuwa cikin raunin a ƙarƙashin sa ido na ainihin lokaci, yana guje wa lalacewar manyan tasoshin da ke kewaye da tsarin zuciya, yana inganta aminci da daidaito. "Ƙaramin EBUS" yana da ƙaramin jiki, wanda ke ba shi damar ganin raunukan huhu a gefen inda na'urorin bronchoscope na gargajiya ba za su iya isa ba. Idan aka yi amfani da shi tare da murfin introverter, yana ba da damar yin samfurin da ya dace.

Binciken Fulawa: Binciken Fulawa na Immunofluorescence Bronchoscopy yana haɗa na'urorin lantarki na gargajiya tare da na'urar haske ta sel da fasahar bayanai don gano raunuka ta amfani da bambance-bambancen haske tsakanin ƙwayoyin ƙari da ƙwayoyin halitta na yau da kullun. A ƙarƙashin takamaiman raƙuman haske na haske, raunuka kafin ciwon daji ko ciwace-ciwacen farko suna fitar da haske na musamman wanda ya bambanta da launin kyallen halitta. Wannan yana taimaka wa likitoci gano ƙananan raunuka waɗanda ke da wahalar ganowa ta hanyar amfani da endoscopy na gargajiya, don haka yana inganta saurin gano cutar kansa ta huhu da wuri.

Na'urorin duba bronchoscopes masu matuƙar siriri:Na'urorin duba ƙwayoyin cuta masu matuƙar siriri wata dabara ce ta endoscopic mai sassauƙa wadda ke da ƙaramin diamita (yawanci ƙasa da 3.0 mm). Ana amfani da su musamman don yin cikakken bincike ko magance yankunan huhu. Babban fa'idarsu tana cikin ikon ganin ƙananan ƙwayoyin cuta a ƙasa da matakin 7, wanda ke ba da damar yin cikakken bincike kan ƙananan raunuka. Suna iya isa ga ƙananan ƙwayoyin cuta waɗanda ke da wahalar isa ta amfani da na'urorin duba ƙwayoyin cuta na gargajiya, suna inganta yawan gano raunuka da wuri da kuma rage raunin tiyata.Wani ƙwararren majagaba a fannin "navigation + robotics":bincika "yankin da ba a tantance ba" na huhu.

Binciken bronchoscopy navigation na lantarki (ENB) kamar sanya na'urar hangen nesa ta hanyar amfani da GPS ne. Kafin a yi tiyata, ana sake gina samfurin huhu na 3D ta amfani da na'urar daukar hoton CT. A lokacin tiyata, fasahar sanya na'urar hangen nesa tana jagorantar endoscope ta cikin rassan bronchial masu rikitarwa, tana mai da hankali kan ƙananan ƙwayoyin huhu na gefe waɗanda suka kai diamita kaɗan (kamar ƙwayoyin gilashi na ƙasa ƙasa da mm 5) don biopsy ko cirewa.

Binciken bronchoscopy mai taimakon robot: Ana sarrafa endoscope ɗin ta hanyar amfani da wani hannu na robot wanda likita ke sarrafawa a na'urar wasan bidiyo, wanda ke kawar da tasirin girgizar hannu da kuma cimma daidaiton matsayi mafi girma. Ƙarshen endoscope ɗin zai iya juyawa digiri 360, wanda ke ba da damar kewayawa mai sassauƙa ta hanyar hanyoyin bronchial masu wahala. Ya dace musamman don yin daidai lokacin tiyatar huhu mai rikitarwa kuma ya riga ya yi tasiri sosai a fannoni na biopsy da ablation na ƙananan ƙwayoyin huhu.

Wasu gwaje-gwajen bronchoscope na gida: