Wararka - Sidee loo doortaa muraayadda bronchoscopy ee carruurta?

Horumarka taariikheed ee bronchoscopy

Fikradda ballaadhan ee bronchoscope waa inay ku jirtaa bronchoscope adag iyo bronchoscope dabacsan ( dabacsanaan leh).

1897kii

Sannadkii 1897-kii, khabiirka laryngologist ee Jarmalka Gustav Killian ayaa sameeyay qalliinkii bronchoscopic ee ugu horreeyay taariikhda - wuxuu isticmaalay bir adag oo loo yaqaan 'endoscope' si uu uga saaro jirka lafaha qalaad ee hawo-mareenka bukaanka.

1904tii

Chevalier Jackson oo ku nool dalka Mareykanka ayaa soo saaray bronchoscope-kii ugu horreeyay.

1962kii

Dhaqtarka Japan Shigeto Ikeda ayaa sameeyay bronchoscope-kii ugu horreeyay ee fiberoptic. Bronchoscope-kan dabacsan, microscopic microscopic, oo cabbiraya dhawr milimitir dhexroorka ah, wuxuu ku gudbiyay sawirro tobanaan kun oo fiilooyinka indhaha ah, taas oo u sahlaysa in si fudud loo geliyo qaybaha iyo xitaa boronkiitada hoose. Horumarkan ayaa u ogolaatay dhakhaatiirta inay indho-indheyn ku sameeyaan dhismooyinka qoto dheer ee sambabada markii ugu horeysay, bukaannadu waxay u dulqaadan karaan baaritaanka suuxdinta gudaha, iyaga oo meesha ka saaraya baahida suuxdinta guud. Imaanshiyaha bronchoscope-ka fiberoptic-ka ayaa ka beddelay bronchoscopy-ka habraacii wax-ka-soo-baxa una beddeley baaris kooban, taasoo fududeyneysa ogaanshaha hore ee cudurrada sida kansarka sanbabada iyo qaaxada.

1966kii

Bishii Luulyo 1966, Machida waxay soo saartay bronchoscope-kii ugu horreeyay ee runta ah ee adduunka. Bishii Ogosto 1966, Olympus waxay sidoo kale soo saartay bronchoscope-kii ugu horreeyay ee fiberoptic. Ka dib, Pentax iyo Fuji ee Japan, iyo Wolf ee Jarmalka, ayaa sidoo kale sii daayay bronchoscopes iyaga u gaar ah.

Bronchoscope-ka fiber-ka:

Olympus XP60, dhexroorka dibadda 2.8mm, kanaalka biopsy 1.2mm

Bronchoscope ka kooban:

Olympus XP260, dhexroorka dibadda 2.8mm, kanaalka biopsy 1.2mm

Taariikhda bronchoscopy ee carruurta ee Shiinaha

Isticmaalka bukaan-socod ee fibreoptic bronchoscopy ee carruurta ku nool waddankeyga waxay bilaabatay 1985, oo ay hormood ka ahaayeen isbitaallada carruurta ee Beijing, Guangzhou, Tianjin, Shanghai, iyo Dalian. Dhisidda aasaaskan, 1990 (si rasmi ah loo aasaasay 1991), Professor Liu Xicheng, oo hoos imaanaya hagidda Professor Jiang Zaifang, wuxuu aasaasay qolkii ugu horreeyay ee bukaan-socodka bronchoscopy ee Shiinaha ee Isbitaalka Carruurta ee Beijing oo xiriir la leh Jaamacadda Capital Medical, taasoo calaamad u ah aasaaska rasmiga ah ee nidaamka tignoolajiyada bronchoscopy ee carruurta ee Shiinaha. Imtixaankii ugu horreeyay ee fiberoptic bronchoscopy ee ilmaha waxaa sameeyay Waaxda Neefsashada ee Isbitaalka Carruurta ee xiriirka la leh Dugsiga Caafimaadka ee Jaamacadda Zhejiang ee 1999, taasoo ka dhigtay mid ka mid ah machadyadii ugu horreeyay ee Shiinaha si nidaamsan u hirgeliya baaritaannada bronchoscopy fiberoptic iyo daaweynta cudurrada carruurta.

Dhexroorka hawo-mareenka ee carruurta da'doodu kala duwan tahay

Sidee loo doortaa noocyo kala duwan oo bronchoscopes ah?

Doorashada qaabka bronchoscope ee carruurta waa in lagu go'aamiyaa iyadoo lagu saleynayo da'da bukaanka, cabbirka marin-haweedka, iyo ogaanshaha iyo daaweynta loogu talagalay. Tilmaamaha loogu talagalay Bronchoscopy Flexable Carruur ee Shiinaha (2018 Edition)" iyo agabyada la xidhiidha waa tixraacyada aasaasiga ah.

Noocyada bronchoscopes ugu horrayn waxaa ka mid ah bronchoscopes fiberoptic, bronchoscopes elektaroonik ah, iyo bronchoscopes isku dhafan. Waxaa jira noocyo badan oo cusub oo gudaha ah oo suuqa ku jira, kuwaas oo qaar badan oo ka mid ah ay yihiin kuwo tayo sare leh. Hadafkayagu waa inaan gaadhno jidh dhuuban, xoog weyn, iyo sawirro cad.

Qaar ka mid ah bronchoscopes dabacsan ayaa la soo bandhigay:

Xulashada Model:

1. Bronchoscopes leh dhexroor 2.5-3.0mm:

Ku habboon dhammaan kooxaha da'da (oo ay ku jiraan dhallaanka cusub). Hadda waxaa laga heli karaa suuqa bronchoscopes leh dhexroorka dibadda ee 2.5mm, 2.8mm, iyo 3.0mm, iyo leh 1.2mm kanaalka shaqeeya. Bronchoscopes-yadani waxay samayn karaan hammi, ogsijiin, nadiifin, biopsy, cadayashada (bristle-fiican), fidinta laysarka, iyo ballaadhinta buufinta oo leh dhexroor 1mm qayb ka-hor-u-ballaadhineed iyo stent bir ah.

2. Bronchoscopes leh dhexroor 3.5-4.0 mm:

Aragti ahaan, tani waxay ku habboon tahay carruurta ka weyn hal sano. Kanaalka shaqada ee 2.0mm wuxuu u oggolaanayaa hababka sida xinjirowga dhiigga, cryoablation, cirbadaha transbronchial aspiration (TBNA), biopsy sambabada transbronchial (TBLB), ballacinta buufinta, iyo meelaynta stent.

Olympus BF-MP290F waa bronchoscope leh dhexroorka dibadda ee 3.5 mm iyo kanaalka 1.7 mm. Dhexroorka sare ee caarada: 3.0 mm (qayb galinta ≈ 3.5 mm); dhexroorka kanaalka: 1.7 mm. Waxay u oggolaanaysaa marinka 1.5 mm xoog-bakhti-qaadis, 1.4 mm baarayaal ultrasound ah, iyo burush 1.0 mm ah. Ogsoonow in 2.0 mm dhexroorka xoog saarista dheecaanku aanu geli karin kanaalkan. Noocyada gudaha sida Shixin sidoo kale waxay bixiyaan tilmaamo la mid ah. Jiilka soo socda ee Fujifilm EB-530P iyo EB-530S bronchoscopes taxane ah ayaa ka muuqda baaxad aad u khafiif ah oo leh dhexroorka sare ee 3.5 mm iyo kanaalka dhexroorka 1.2 mm. Waxay ku habboon yihiin baaritaanka iyo ka-hortagga nabarrada sambabada ee sambabada ee goobaha carruurta iyo dadka waaweyn labadaba. Waxay la jaan qaadayaan burushyada cytology ee 1.0 mm, 1.1 mm xoog-qaadis-qaadis ah, iyo 1.2 mm xoog qalaad oo jireed.

3. Bronchoscopes leh dhexroor 4.9 mm ama ka weyn:

Guud ahaan ku habboon carruurta da'doodu tahay 8 sano iyo ka weyn oo miisaankoodu yahay 35 kg ama ka badan. Kanaalka shaqeeya ee 2.0 mm wuxuu u oggolaanayaa hababka sida xinjirowga dhiigga, cryoablation, cirbadaha transbronchial aspiration (TBNA), biopsy sambabada transbronchial (TBLB), ballaarinta buufinta, iyo meelaynta stent. Qaar ka mid ah bronchoscopes waxay leeyihiin kanaal shaqeynaya in ka badan 2 mm, taasoo ka dhigaysa inay ku habboon yihiin hababka dhexgalka.

Dhexroorka

4. Kiisaska Gaarka ah: Ultrathin bronchoscopes leh dhexroorka dibadda ee 2.0 mm ama 2.2 mm oo aan kanaal shaqaynayn loo isticmaali karo si loo baaro marinnada hawadu ee fog ee dhallaanka dhicis ama wakhtiga buuxa. Waxay sidoo kale ku habboon yihiin baaritaannada marin-haweedka ee dhallaanka yaryar ee leh stenosis marin-haweedka daran.

Marka la soo koobo, qaabka ku habboon waa in lagu doortaa da'da bukaanka, cabbirka marinka hawo-mareenka, iyo ogaanshaha iyo baahida daawaynta si loo xaqiijiyo habraac guul iyo badbaado leh.

Waxyaalaha qaar in la xuso markaad dooranayso muraayad:

Inkastoo 4.0mm dhexroorka bronchoscopes ay ku habboon yihiin carruurta da'doodu ka weyn tahay 1 sano, hawlgalka dhabta ah, 4.0mm dhexroor bronchoscopes dibadda way adag tahay in la gaaro lumen qoto dheer ee boronkiitada carruurta da'doodu tahay 1-2 sano jir. Sidaa darteed, carruurta da'doodu ka yar tahay 1 sano, 1-2 sano, oo miisaankoodu ka yar yahay 15kg, 2.8mm khafiif ah ama 3.0mm dhexroorka bronchoscopes ayaa guud ahaan loo isticmaalaa hawlgallada caadiga ah.

Carruurta da'doodu tahay 3-5 sano oo miisaankoodu yahay 15kg-20kg, waxaad dooran kartaa muraayad khafiif ah oo leh dhexroorka dibadda ee 3.0mm ama muraayad leh dhexroorka dibadda ee 4.2mm. Haddii sawirku muujiyo in uu jiro aag weyn oo atelectasis ah iyo fiilada xaakada ay u badan tahay in la xannibo, waxaa lagu talinayaa in la isticmaalo muraayad leh dhexroorka dibadda ee 4.2mm marka hore, kaas oo leh soo jiidasho xoog leh oo la nuugi karo. Ka dib, muraayad khafiif ah oo 3.0mm ah ayaa loo isticmaali karaa qodista qoto dheer iyo sahaminta. Haddii PCD, PBB, iwm la tixgeliyo, iyo carruurtu waxay u nugul yihiin qadar badan oo dheecaan ah, waxaa sidoo kale lagu talinayaa in la doorto muraayad qaro leh oo leh dhexroorka dibadda ee 4.2mm, taas oo sahlan in la soo jiito. Intaa waxaa dheer, muraayad leh dhexroorka dibadda ee 3.5mm ayaa sidoo kale la isticmaali karaa.

Carruurta da'doodu tahay 5 sano ama ka weyn oo miisaankoodu yahay 20 kg ama ka badan, 4.2 mm dhexroorka bronchoscope ayaa guud ahaan doorbidaya. Kanaalka xoogga ah ee 2.0 mm wuxuu fududeeyaa wax-is-daba-marinta iyo nuugista.

Si kastaba ha ahaatee, 2.8/3.0 mm dhexroor ka khafiifsan bronchoscope waa in lagu doortaa xaaladaha soo socda:

① stenosis marin-haweedka anatomical:

• stenosis marin-haweedka ku dhasha ama qalliinka kadib, tracheobronchomalacia, ama stenosis cadaadis dibadda ah. Dhexdhexaadiyaha gudaha ee qaybta sare ee glottic ama ugu cidhiidhi bronki <5 mm.

② Dhaawaca marin-haweedka dhawaa ama barar

• bararka glottic/subglottic bararka ka dib, gubashada endotracheal, ama dhaawaca neefsashada.

③ Qallal daran ama cidhiidhi xagga neefsiga ah

• Laryngotracheobronchitis ba'an ama xaalad asthmaticus oo daran oo u baahan xanaaq yar.

④ Jidka sanka ee sanka oo cidhiidhi ah

• stenosis weyn ee marinka sanka ee sanka ama turbinate hoose inta lagu jiro sanka gelinta, ka hortagga marinka 4.2 mm endoscope dhaawac la'aan.

⑤ Shuruudaha lagu galo durugsan (fasalka 8 ama ka sare) bronchus.
• Xaaladaha qaarkood ee pneumonia ba'an ee Mycoplasma oo leh atelectasis, haddii dhowr jeermisyada bronchoscopic alveolar ee marxaladda ba'an ay weli ku guuldareystaan inay soo celiyaan atelectasis, endoscope ganaax ah ayaa loo baahan karaa si qoto dheer loo geliyo bronchoscope fog si loo sahamiyo loona daweeyo xaakada yaryar, qoto dheer. • Kiisaska looga shakisan yahay xannibaadda boronkiitada (BOB), daba-galka oof-wareenka daran, endoscope ganaax ah ayaa loo isticmaali karaa in si qoto dheer loo geliyo laamo-hoosaadyada iyo qaybaha hoose ee qaybta sambabada ay saamaysay. • Xaaladaha atresia bronki ee lagu dhasho, qodista qoto dheer oo leh endoscope ganaax ah ayaa sidoo kale lagama maarmaan u ah atresia bronki. • Intaa waxaa dheer, nabarrada firidhsan ee fidsan (sida dhiig-baxa alveolar ee fidsan iyo qanjidhada durugsan) waxay u baahan yihiin endoscope fiican.

⑥ Qallafsanaanta afka ilmagaleenka ama maxillofacial

• Micromandibular ama craniofacial syndromes (sida Pierre-Robin syndrome) xaddidaya booska oropharyngeal.

⑦ Waqti yar oo habraac ah, oo u baahan kaliya baaritaanka ogaanshaha

• Kaliya BAL, cadayashada, ama cadaymo fudud ayaa loo baahan yahay; looma baahna qalab waaweyn, iyo endoscope khafiif ah ayaa yarayn kara xanaaqa.

⑧ Dabagalka qalliinka kadib

• Bronchoscopy-da adag ee dhawaanahan ama ballaadhinta buufinta si loo yareeyo dhaawaca xabkaha sare.

Marka la soo koobo:

"Stenosis, bararka, neefta oo ku dhegta, naaso yaryar, durugsan qoto dheer, qallafsanaan, waqtiga baaritaanka gaaban, iyo soo kabashada qalliinka ka dib" - haddii mid ka mid ah xaaladahan uu jiro, u beddel 2.8-3.0 mm khafiif ah endoscope.

4. Carruurta da'doodu tahay> 8 sano oo miisaankeedu yahay> 35 kg, endoscope leh dhexroorka dibadda ee 4.9 mm ama ka weyn ayaa loo dooran karaa. Si kastaba ha ahaatee, bronchoscopy-ga joogtada ah, endoscopes khafiif ah ayaa ka cadhaysiinaya bukaanka waxayna yareeyaan khatarta dhibaatooyinka haddii aan loo baahnayn faragelin khaas ah.

5. Fujifilm noociisa EBUS ee aasaasiga ah ee hadda jira waa EB-530US. Tilmaamaha ugu muhiimsan waa sida soo socota: dhexroorka dibedda ee fog: 6.7 mm, dhexroorka tuubada gelinta: 6.3 mm, kanaalka shaqada: 2.0 mm, dhererka shaqada: 610 mm, iyo dhererka guud: 880 mm. Da'da iyo miisaanka lagu taliyay: Iyadoo ay ugu wacan tahay dhexroorka fog ee 6.7 mm ee endoscope, waxaa lagula talinayaa carruurta da'doodu tahay 12 sano iyo ka weyn ama miisaankoodu yahay> 40 kg.

Olympus Ultrasonic Bronchoscope: (1) EBUS toosan (Taxane BF-UC190F): ≥12 jir, ≥40 kg. (2) Radial EBUS + Ultrathin Mirror (Taxane BF-MP290F): ≥6 jir, ≥20 kg; Carruurta yaryar, dhexroorka baaritaanka iyo muraayadaha waxay u baahan yihiin in la sii yareeyo.

Hordhac bronchoscopy kala duwan

Bronchoscopes waxaa loo kala saaraa iyadoo loo eegayo qaab-dhismeedkooda iyo mabaadi'da sawirka qaybaha soo socda:

Bronchoscopes fiber

Bronchoscopes elektaroonik ah

Bronchoscopes la isku daray

Bronchoscopes autofluorescence

Ultrasound bronchoscopes

……

Fiberoscopy bronchoscopy:

Bronchoscope elektaroonik ah:

Bronchoscope ka kooban:

Bronchoscopes kale:

Ultrasound bronchoscopes (EBUS): Baadhitaanka ultrasound ee lagu dhex daray cidhifka hore ee qalabka elektarooniga ah waxaa loo yaqaan "mareenka hawada B-ultrasound." Waxay geli kartaa darbiga marin-haweedka waxayna si cad u arki kartaa qanjidhada dhexe ee qanjidhada, xididdada dhiigga, iyo burooyinka ka baxsan hawo-mareenka. Waxay si gaar ah ugu habboon tahay daaweynta bukaanka kansarka sanbabada. Iyada oo la marinayo daloolin uu hagayo ultrasound, shaybaarada qanjidhada dhexda dhexe ayaa si sax ah loo heli karaa si loo go'aamiyo in burada ay metaastay iyo in kale, lagana yaabo in laga fogaado dhaawaca thoracotomy dhaqameed. EBUS waxay u qaybsantaa "EBUS weyn" oo loogu kuurgalayo nabarada hareeraha marinnada hawadu mareenka weyn iyo "EBUS yar" (oo leh baaritaan durugsan) si loo eego nabarada sambabada ee ku wareegsan. "EBUS weyn" waxay si cad u muujineysaa xiriirka ka dhexeeya xididada dhiigga, qanjidhada qanjidhada, iyo nabarrada meel bannaan ee ku jira gudaha mediastinum ee ka baxsan marinnada hawada. Waxa kale oo ay u ogolaataa rabitaanka cirbadda transbronchial si toos ah dhaawaca iyada oo la kormeerayo wakhtiga dhabta ah, si wax ku ool ah looga fogaado waxyeelada ku wareegsan maraakiibta waaweyn iyo qaababka wadnaha, hagaajinta badbaadada iyo saxnaanta. "EBUS-yar" waxay leedahay jir yar, taas oo u oggolaanaysa inay si cad u aragto nabarrada sambabada ee sambabada halkaasoo bronchoscopes caadiga ah aysan gaari karin. Marka lagu isticmaalo galka soo-bandhiga, waxay u oggolaanaysaa muunad sax ah oo dheeraad ah.

Bronchoscopy Fluorescence: Bronchoscopy Immunofluorescence wuxuu isku daraa bronchoscopes elektaroonig ah oo caadi ah oo leh autofluorescence gacanta iyo tignoolajiyada macluumaadka si loo aqoonsado dhaawacyada iyadoo la adeegsanayo farqiga u dhexeeya fluorescence u dhexeeya unugyada burooyinka iyo unugyada caadiga ah. Marka la eego mowjadaha dhaadheer ee iftiinka, nabarrada hore ee kansarka ama burooyinka marxaladda hore waxay soo saaraan fluorescence gaar ah oo ka duwan midabka unugyada caadiga ah. Tani waxay ka caawisaa dhakhaatiirta inay ogaadaan nabaro yaryar oo ay adag tahay in lagu ogaado endoscopy-ga caadiga ah, taas oo hagaajinaysa heerka hore ee ogaanshaha kansarka sanbabada.

Bronchoscopes dhuuban:Bronchoscopes aadka u dhuuban waa farsamo endoscopic dabacsan oo leh dhexroor yar (sida caadiga ah <3.0 mm). Waxa ugu horrayn loo isticmaalaa baadhitaan sax ah ama daawaynta gobollada sambabada fog. Faa'iidadooda muhiimka ah waxay ku jirtaa awoodda ay u leeyihiin inay ku sawiraan boronkiitada qaybta hoose ee ka hooseeya heerka 7, taasoo awood u siinaysa baaritaan faahfaahsan oo nabarro daahsoon ah. Waxay gaari karaan boronkiito yaryar oo ay adag tahay in lagu gaaro bronchoscopes dhaqameed, hagaajinta heerka ogaanshaha nabarrada hore iyo yaraynta dhaawacyada qalliinka.Horjooge cidhiidhi ah oo ku jira "navigation + robotics":sahaminta "dhulka aan la ogeyn" ee sambabada.

Bronchoscopy navigation elektromagnetic (ENB) waa sida qalabaynta bronchoscope leh GPS. Qalliin ka hor, qaabka sambabada 3D ayaa dib loo dhisay iyadoo la isticmaalayo CT scans. Inta lagu jiro qalliinka, tignoolajiyada meelaynta korantada ayaa hagta endoscope iyada oo loo marayo laamo boronkiino ah oo adag, si sax ah loo beegsanayo qanjidhada sambabada ee yaryar ee cabbiraya kaliya dhowr millimitir oo dhexroor ah (sida qanjidhada dhulka ee ka hooseeya 5 mm) biopsy ama ka saarista.

Bronchoscopy-caawinta Robot-ka: Endoscope-ka waxa gacanta ku haya gacan-robot oo uu takhtarku ku shaqeeyo console-ka, isaga oo meesha ka saaraya saamaynta gariirrada gacanta iyo gaarista saxnaanta meelaynta sare. Dhammaadka endoscope wuxuu wareegi karaa 360 darajo, taas oo u oggolaanaysa socodka dabacsan ee marinnada boronkiitada daran. Waxay si gaar ah ugu habboon tahay wax-is-daba-marin sax ah inta lagu jiro qalliinnada sambabada ee adag waxayna durba saameyn weyn ku yeelatay dhinacyada ka-soo-baxa qanjidhada sanbabada yar-yar iyo baabi'inta.

Qaar ka mid ah bronchoscopes gudaha: