Labarai - Yadda za a zabi madubi don bronchoscopy na yara?

Ci gaban tarihi na bronchoscopy

Babban ra'ayi na bronchoscope ya kamata ya haɗa da m bronchoscope da m (m) bronchoscope.

1897

A shekara ta 1897, masanin laryngologist na Jamus Gustav Killian ya yi tiyatar bronchoscopic ta farko a tarihi - ya yi amfani da endoscope na ƙarfe mai tsauri don cire wani ƙashi na waje daga cikin majiyyaci.

1904

Chevalier Jackson a Amurka ya kera na'urar buronchoscope na farko.

1962

Likitan dan kasar Japan Shigeto Ikeda ya kirkiri sinadarin bronchoscope na farko na fiberoptic. Wannan mai sassauƙa, ɗan ƙaramin ɗan ƙaramin abu, wanda ke auna ƴan milimita kaɗan a diamita, ya watsa hotuna ta dubun dubatar filaye na gani, yana ba da damar shigar da sauƙi cikin ɓangarori har ma da ɓangarori. Wannan ci gaban ya baiwa likitoci damar kallon tsarin da ke cikin huhu a karon farko, kuma marasa lafiya za su iya jure wa gwajin a karkashin maganin sa barci na gida, tare da kawar da buƙatar maganin sa barci. Zuwan fiberoptic bronchoscope ya canza bronchoscopy daga hanyar da ba ta dace ba zuwa jarrabawa kaɗan, yana sauƙaƙe gano farkon cututtuka irin su ciwon huhu da tarin fuka.

1966

A cikin Yuli 1966, Machida ya samar da bronchoscope na farko na fiberoptic na gaskiya a duniya. A watan Agusta 1966, Olympus kuma ya samar da bronchoscope na farko na fiberoptic. Daga baya, Pentax da Fuji a Japan, da Wolf a Jamus, su ma sun fitar da nasu na'urar buronchoscopes.

Bronchoscope na fiber:

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

Bronchoscope hadaddun:

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

Tarihin bronchoscopy na yara a kasar Sin

An fara amfani da aikin likitancin likitanci na fiberoptic bronchoscopy a cikin yara a ƙasata a cikin 1985, asibitocin yara a Beijing, Guangzhou, Tianjin, Shanghai, da Dalian suka yi hidimar majagaba. Gina kan wannan tushe, a shekarar 1990 (wanda aka kafa a hukumance a shekarar 1991), Farfesa Liu Xicheng, karkashin jagorancin Farfesa Jiang Zaifang, ya kafa dakin kula da kananan yara na kasar Sin na farko a asibitin yara na Beijing dake da alaka da Jami'ar Kiwon Lafiya ta Capital, wanda ya nuna a hukumance na kafa tsarin fasahar likitancin yara na kasar Sin. Sashen numfashi na asibitin yara dake da alaka da makarantar koyon aikin likitanci na jami'ar Zhejiang ne ya gudanar da jarrabawar farko a cikin yaro a shekarar 1999, wanda hakan ya sa ya zama daya daga cikin cibiyoyin farko a kasar Sin da ke aiwatar da gwaje-gwaje da jiyya a fannin ilimin yara bisa tsari.

Diamita na tracheal na yara a shekaru daban-daban

Yadda za a zabi daban-daban model na bronchoscopes?

Zaɓin samfurin bronchoscope na yara ya kamata a ƙayyade bisa ga shekarun majiyyaci, girman hanyar iska, da ganewar asali da magani. "Jagorori don m brokchoscopy m brelicycy a cikin childricy a China (2018 bugu)" Abubuwan da ke da alaƙa da mahimman nassoshi ne na farko.

Nau'in Bronchoscope da farko sun haɗa da fiberoptic bronchoscopes, bronchoscopes na lantarki, da haɗin bronchoscopes. Akwai sabbin kayayyaki na cikin gida da yawa a kasuwa, yawancinsu suna da inganci. Manufarmu ita ce cimma mafi ƙarancin jiki, babban ƙarfi, da ƙarin hotuna masu haske.

An gabatar da wasu nau'ikan bronchoscopes masu sassauƙa:

Zaɓin Samfura:

1. Bronchoscopes tare da diamita na 2.5-3.0mm:

Ya dace da kowane rukunin shekaru (ciki har da jarirai). A halin yanzu ana samun su a kasuwa akwai bronchoscopes tare da diamita na waje na 2.5mm, 2.8mm, da 3.0mm, kuma tare da tashar aiki na 1.2mm. Wadannan bronchoscopes na iya yin buri, oxygenation, lavage, biopsy, brushing (fine-bristle), Laser dilatation, da balloon dilatation tare da diamita 1mm pre-dilatation sashe da karfe stent.

2. Bronchoscopes tare da diamita na 3.5-4.0 mm:

A ka'ida, wannan ya dace da yara sama da shekara ɗaya. Tashar aikinta na mm 2.0 yana ba da damar hanyoyin kamar su electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial huhu biopsy (TBLB), dilatation balan-balan, da stent jeri.

Olympus BF-MP290F bronchoscope ne tare da diamita na waje na 3.5 mm da tashar 1.7 mm. Tukwici diamita na waje: 3.0 mm (bangaren sakawa ≈ 3.5 mm); tashar ciki diamita: 1.7 mm. Yana ba da damar 1.5 mm biopsy forceps, 1.4 mm duban dan tayi, da 1.0 mm goge. Lura cewa 2.0 mm diamita na biopsy forceps ba zai iya shiga wannan tashar ba. Kamfanonin gida kamar Shixin suma suna ba da ƙayyadaddun bayanai iri ɗaya. Fujifilm na gaba-ƙarni EB-530P da EB-530S jerin bronchoscopes ƙunshi wani matsananci-bakin ciki ikon yinsa tare da wani waje diamita na 3.5 mm da 1.2 mm ciki diamita tashar. Sun dace da jarrabawa da shiga tsakani na cututtukan huhu na gefe a cikin tsarin yara da manya. Sun dace da 1.0mm cytology brushes, 1.1 mm biopsy forceps, da 1.2 mm na waje karfi.

3. Bronchoscopes tare da diamita na 4.9 mm ko mafi girma:

Gabaɗaya ya dace da yara masu shekaru 8 zuwa sama da nauyin kilogiram 35 ko fiye. Tashar aiki ta mm 2.0 tana ba da damar hanyoyin kamar su electrocoagulation, cryoablation, transbronchial needle aspiration (TBNA), transbronchial lung biopsy (TBLB), balloon dilatation, da stent jeri. Wasu bronchoscopes suna da tashar aiki fiye da 2 mm, yana sa su fi dacewa da hanyoyin shiga tsakani.

Diamita

4. Abubuwa na Musamman: Ultrathin bronchoscopes tare da diamita na waje na 2.0 mm ko 2.2 mm kuma ba za a iya amfani da tashar aiki don bincika ƙananan ƙananan hanyoyin iska na jarirai waɗanda ba su da lokaci ko cikakken lokaci. Har ila yau, sun dace da gwaje-gwaje na iska a cikin ƙananan jarirai tare da mummunan ƙwayar iska.

A takaice, ya kamata a zaɓi samfurin da ya dace bisa la'akari da shekarun mai haƙuri, girman hanyar iska, da bincike da kuma buƙatar jiyya don tabbatar da nasara da aminci.

Wasu abubuwan lura lokacin zabar madubi:

Ko da yake 4.0mm diamita na waje bronchoscopes dace da yara fiye da shekara 1, a cikin ainihin aiki, 4.0mm diamita na waje bronchoscopes da wuya a kai ga zurfin Bronchial lumen na yara masu shekaru 1-2 shekaru. Don haka, ga yara 'yan ƙasa da shekara 1, masu shekaru 1-2, da nauyin ƙasa da 15kg, ana amfani da bronchoscope na waje na bakin ciki 2.8mm ko 3.0mm don ayyukan yau da kullun.

Ga yara masu shekaru 3-5 da nauyin 15kg-20kg, za ku iya zaɓar madubi na bakin ciki tare da diamita na waje na 3.0mm ko madubi tare da diamita na waje na 4.2mm. Idan hoton ya nuna cewa akwai babban yanki na atelectasis kuma ana iya toshe sputum toshe, ana bada shawarar yin amfani da madubi tare da diamita na waje na 4.2mm da farko, wanda ke da jan hankali mai ƙarfi kuma ana iya tsotse shi. Daga baya, ana iya amfani da madubi na bakin ciki na 3.0mm don zurfin hakowa da bincike. Idan ana la'akari da PCD, PBB, da dai sauransu, kuma yara suna da haɗari ga babban adadin purulent secretions, an kuma bada shawarar zaɓar madubi mai kauri tare da diamita na waje na 4.2mm, wanda ke da sauƙin jawo hankali. Bugu da ƙari, ana iya amfani da madubi tare da diamita na waje na 3.5mm.

Ga yara masu shekaru 5 ko sama da haka kuma masu nauyin kilogiram 20 ko fiye, an fi so a gabaɗaya diamita na 4.2 mm bronchoscope. Tashar tilastawa mm 2.0 tana sauƙaƙe magudi da tsotsa.

Duk da haka, ya kamata a zaɓi bronchoscope na bakin ciki 2.8/3.0 mm a cikin yanayi masu zuwa:

① Anatomical airway stenosis:

• Tashin iska na haihuwa ko bayan tiyata, tracheobronchomalacia, ko matsawa na waje. • Diamita na ciki na ɓangaren subglottic ko mafi ƙunci mai zurfi <5 mm.

② Ciwon kai na kwanan nan ko kumburin iska

• Bayan intubation glottic/ subglottic edema, konewar endotracheal, ko rauni na numfashi.

③ Tsanani mai tsanani ko damuwa na numfashi

• Mummunan laryngotracheobronchitis ko matsayi mai tsanani na asthmaticus wanda ke buƙatar ƙarancin haushi.

④ Hanyar hanci tare da kunkuntar bude hanci

• Mahimmancin stenosis na hancin vestibule ko turbinate maras kyau yayin shigar da hanci, yana hana wucewar endoscope na 4.2 mm ba tare da rauni ba.

⑤ Bukatun don kutsa kai cikin yanki (jin 8 ko sama) bronchus.
A wasu lokuta na ciwon huhu na Mycoplasma mai tsanani tare da atelectasis, idan yawancin bronchoscopic alveolar lavages a cikin m lokaci har yanzu sun kasa dawo da atelectasis, ana iya buƙatar endoscope mai kyau don yin rami mai zurfi a cikin bronchoscope mai nisa don ganowa da kuma kula da ƙananan ƙananan sputum matosai. • A cikin lokuta da ake zargi da toshewar burowa (BOB), wani nau'in ciwon huhu mai tsanani, za a iya amfani da kyakkyawan endoscope don yin rami mai zurfi a cikin rassa da ƙananan sassan ɓangaren huhu da ya shafa. • A cikin lokuta na atresia na bronchial na haihuwa, hakowa mai zurfi tare da kyakkyawan endoscope kuma yana da mahimmanci don atresia mai zurfi. • Bugu da ƙari, wasu raunuka na gefe (kamar zubar da jini na alveolar da kuma nodules na gefe) suna buƙatar mafi kyawun endoscope.

⑥ Nakasar mahaifa ko maxillofacial mai haɗuwa

• Micromandibular ko craniofacial syndromes (kamar ciwo na Pierre-Robin) yana ƙuntata sararin oropharyngeal.

⑦ gajeriyar lokacin hanya, yana buƙatar jarrabawar bincike kawai

• BAL kawai, gogewa, ko biopsy mai sauƙi ake buƙata; ba a buƙatar manyan kayan aiki, kuma endoscope na bakin ciki zai iya rage fushi.

⑧ Bibiya bayan aiki

• Kwanan nan m bronchoscopy ko fadada balloon don rage raunin mucosal na biyu.

A takaice:

"Stenosis, edema, shortness of breath, small nares, deep periphery, deformity, short time exam, and postoperative farfadowa" - idan akwai wani daga cikin wadannan yanayi, canza zuwa 2.8-3.0 mm bakin ciki endoscope.

4. Ga yara masu shekaru> 8 da nauyin nauyi> 35 kg, za a iya zaɓin endoscope tare da diamita na waje na 4.9 mm ko mafi girma. Duk da haka, don bronchoscopy na yau da kullum, ƙananan endoscopes ba su da fushi ga majiyyaci kuma suna rage haɗarin rikitarwa sai dai idan an buƙaci sa hannu na musamman.

5. Fujifilm na yanzu firamare na yara EBUS model ne EB-530US. Maɓallin maɓallinsa sune kamar haka: distal na waje: 6.7 mm, diamita bututu na waje: 6.3 mm, tashar aiki: 2.0 mm, tsayin aiki: 610 mm, da tsayin duka: 880 mm. Shawarar shekaru da nauyi: Saboda nisan diamita na 6.7 mm na endoscope, ana ba da shawarar ga yara masu shekaru 12 ko sama da su ko auna> 40 kg.

Olympus Ultrasonic Bronchoscope: (1) Linear EBUS (BF-UC190F Series): ≥12 shekaru, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (BF-MP290F Series): ≥6 shekaru, ≥20 kg; ga yara ƙanana, bincike da diamita na madubi suna buƙatar ƙara rage su.

Gabatarwa zuwa daban-daban bronchoscopy

Bronchoscopes an rarraba su bisa ga tsarin su da ka'idodin hoto zuwa cikin nau'i masu zuwa:

Fiberoptic bronchoscopes

Electronic bronchoscopes

Haɗaɗɗen bronchoscopes

Autofluorescence bronchoscopes

Ultrasound bronchoscopes

……

Fiberoptic bronchoscopy:

Bronchoscope na lantarki:

Bronchoscope hadaddun:

Sauran bronchoscopes:

Ultrasound bronchoscopes (EBUS): Binciken duban dan tayi da aka haɗa a cikin ƙarshen ƙarshen na'urar lantarki da aka sani da "hanyar iska B-ultrasound." Zai iya shiga bangon hanyar iska kuma a fili ya hango nodes na lymph nodes, tasoshin jini, da ciwace-ciwacen daji a wajen trachea. Ya dace musamman don tantance marasa lafiya da ciwon huhu. Ta hanyar huda mai shiryarwa na duban dan tayi, ana iya samun samfuran kuɗaɗɗen ƙwayar cuta na mediastinal daidai don sanin ko ƙwayar ta taso, mai yuwuwar guje wa rauni na thoracotomy na gargajiya. An raba EBUS zuwa "babban EBUS" don lura da raunuka a kusa da manyan hanyoyin iska da "kananan EBUS" (tare da bincike na gefe) don lura da raunin huhu na gefe. "Babban EBUS" yana nuna a fili alakar da ke tsakanin hanyoyin jini, nodes na lymph, da raunuka masu mamaye sararin samaniya a cikin mediastinum a wajen hanyoyin iska. Hakanan yana ba da damar buƙatun allurar transbronchial kai tsaye zuwa cikin rauni a ƙarƙashin kulawa ta ainihi, yadda ya kamata guje wa lalacewa ga manyan tasoshin da ke kewaye da tsarin zuciya, haɓaka aminci da daidaito. "Ƙananan EBUS" yana da ɗan ƙaramin jiki, yana ba shi damar iya gani a fili raunuka na huhu inda bronchoscopes na al'ada ba zai iya isa ba. Lokacin amfani da kumfa mai gabatarwa, yana ba da damar yin samfuri daidai.

Fluorescence bronchoscopy: Immunofluorescence bronchoscopy yana haɗuwa da bronchoscopes na al'ada na lantarki tare da autofluorescence na salula da fasaha na bayanai don gano raunuka ta amfani da bambance-bambancen haske tsakanin ƙwayoyin tumo da kwayoyin halitta. Ƙarƙashin ƙayyadaddun raƙuman haske na ƙayyadaddun raƙuman ruwa, raunin da ya faru da ciwon daji ko kuma ciwace-ciwacen farko-farko suna fitar da wani haske na musamman wanda ya bambanta da launi na al'ada. Wannan yana taimaka wa likitoci gano ƙananan raunuka waɗanda ke da wahalar ganowa tare da endoscopy na al'ada, don haka inganta saurin gano cutar kansar huhu.

Bronchoscopes mai bakin ciki:Bronchoscopes-bakin ciki shine mafi sassaucin fasaha na endoscopic tare da ƙaramin diamita (yawanci <3.0 mm). Ana amfani da su da farko don yin nazari daidai ko kuma kula da yankunan huhu mai nisa. Babban fa'idarsu ta ta'allaka ne a cikin ikonsu na iya hangen nesa na ɓangarori na ƙasa da ƙasa na matakin 7, yana ba da damar ƙarin cikakken bincike na raunuka marasa hankali. Za su iya kai ga ƙananan ƙananan ƙwayoyin cuta waɗanda ke da wuya a kai tare da bronchoscopes na al'ada, inganta yawan gano cututtuka na farko da kuma rage raunin tiyata.Babban majagaba a cikin " kewayawa + mutum-mutumi":bincika "yankin da ba a tantance ba" na huhu.

Bronchoscopy na kewayawa na lantarki (ENB) kamar ba da kayan aikin bronchoscope ne tare da GPS. Kafin yin aiki, ana sake gina samfurin huhu na 3D ta amfani da CT scans. A lokacin tiyata, fasahar sakawa ta lantarki tana jagorantar endoscope ta hadaddun rassan bunchial, daidai da niyya ga ƙananan nodules na huhu waɗanda ke auna ƴan milimita kaɗan kawai a diamita (kamar nodules-gilashin ƙasa ƙarƙashin 5 mm) don biopsy ko ablation.

Bronchoscopy na taimakon robot: Ana sarrafa ƙarshen ƙarshen ta hannun mutum-mutumi da likita ke sarrafa shi a na'urar wasan bidiyo, yana kawar da tasirin rawar hannu da samun daidaiton matsayi mafi girma. Ƙarshen ƙarshen endoscope na iya juya digiri 360, yana ba da izinin kewayawa mai sassauƙa ta hanyoyi masu banƙyama. Ya dace sosai don yin magudi a lokacin hadadden aikin tiyatar huhu kuma ya riga ya yi tasiri sosai a fagagen ƙananan nodule na huhu da kuma zubar da ciki.

Wasu bronchoscopes na gida: