Ngā Pūrongo - Me pēhea te whiriwhiri i tētahi whakaata mō te tirotiro i te pūkahukahu o ngā tamariki?

Te whanaketanga hītori o te bronchoscopy

Ko te ariā whānui o te pūkahukahu me whakauru te pūkahukahu mārō me te pūkahukahu ngāwari (ngāwari).

1897

I te tau 1897, i mahia e te tohunga roro Tiamana a Gustav Killian te pokanga bronchoscopic tuatahi i roto i te hītori - i whakamahia e ia he endoscope whakarewa pakari hei tango i te tinana ke wheua mai i te trachea o te tūroro.

1904

Nā Chevalier Jackson i hanga te pūkahukahu tuatahi i te United States.

1962

Nā te tākuta Hapanihi, nā Shigeto Ikeda, i whakawhanake te pūkahukahu whatu muka tuatahi. Nā tēnei pūkahukahu whatu ngāwari, iti noa te whānui, i tuku whakaahua mā roto i ngā mano tini o ngā muka whatu, ā, ka taea te whakauru ngāwari ki roto i ngā pūkahukahu wāhanga me ngā pūkahukahu wāhanga-iti. Nā tēnei putanga hou i taea ai e ngā tākuta te tirotiro ā-kanohi i ngā hanganga hohonu o roto i ngā pūkahukahu mō te wā tuatahi, ā, ka taea e ngā tūroro te manawanui ki te tirotiro i raro i te rongoā whakamoe ā-rohe, ka kore ai e hiahiatia he rongoā whakamoe whānui. Nā te taenga mai o te pūkahukahu whatu muka i huri te rongoā whakamoe mai i te tikanga whakaeke ki te tirotiro iti rawa te whakaeke, ka āwhina i te tautuhi wawe i ngā mate pēnei i te mate pukupuku pūkahukahu me te mate kohi.

1966

I te marama o Hūrae 1966, i hangaia e Machida te pūkahukahu muka whatu tuatahi o te ao. I te marama o Ākuhata 1966, i hangaia hoki e Olympus tana pūkahukahu muka whatu tuatahi. I muri mai, i tukuna anō e Pentax me Fuji i Hapani, me Wolf i Tiamana, ā rātou ake pūkahukahu.

Pūnaha tirotiro muka whatu:

Olympus XP60, te whānui o waho 2.8mm, te hongere koiora 1.2mm

Pūnaha tirotiro pūhui:

Olympus XP260, te whānui o waho 2.8mm, te hongere koiora 1.2mm

Hītori o te bronchoscopy tamariki i Haina

I tīmata te whakamahinga haumanu o te bronchoscopy muka-whatu i roto i ngā tamariki o tōku whenua i te tau 1985, i tīmatahia e ngā hōhipera tamariki i Beijing, Guangzhou, Tianjin, Shanghai, me Dalian. I runga i tēnei turanga, i te tau 1990 (i whakatūria mana i te tau 1991), i raro i te arataki a Ahorangi Liu Xicheng, i whakatūria te rūma bronchoscopy tamariki tuatahi o Haina i te Hōhipera Tamariki o Beijing e hono ana ki te Whare Wānanga Hauora o Capital, hei tohu i te whakatūnga mana o te pūnaha hangarau bronchoscopy tamariki o Haina. Ko te whakamātautau bronchoscopy muka-whatu tuatahi i roto i te tamaiti i mahia e te Tari Manawa i te Hōhipera Tamariki e hono ana ki te Kura Hauora o te Whare Wānanga o Zhejiang i te tau 1999, ā, koia tētahi o ngā whare wānanga tuatahi i Haina ki te whakatinana i ngā whakamātautau me ngā maimoatanga bronchoscopy muka-whatu i roto i ngā tamariki.

Te diameter o te trachea o ngā tamariki i ngā tau rerekē

Me pēhea te whiriwhiri i ngā tauira rerekē o ngā bronchoscopes?

Me whakatau te tauira o te bronchoscopy tamariki i runga i te tau o te tūroro, te rahi o te ara manawa, me te tātaritanga me te maimoatanga e hiahiatia ana. Ko ngā "Guidelines for Pediatric Flexible Bronchoscope in China (2018 Edition)" me ngā rauemi e pā ana ko ngā tohutoro matua.

Ko ngā momo pūwero irahiko ko ngā pūwero muka whatu, ngā pūwero hiko, me ngā pūwero whakakotahi. He maha ngā waitohu hou o te motu kei te mākete, he maha o ēnei he kounga teitei. Ko tā mātou whāinga he angiangi ake te tinana, he nui ake ngā pūwero, me ngā whakaahua mārama ake.

Kua whakaurua mai ētahi bronchoscopes ngāwari:

Kōwhiringa Tauira:

1. Ngā Pūnaha tirotiro kanohi me te diameter o te 2.5-3.0mm:

He pai mō ngā reanga katoa (tae atu ki ngā pēpi hou). Kei te mākete i tēnei wā ko ngā bronchoscopes me ngā diameter o waho o te 2.5mm, 2.8mm, me te 3.0mm, ā, he hongere mahi 1.2mm. Ka taea e ēnei bronchoscopes te mahi i te tangohanga, te tango hāora, te horoi, te tango koiora, te paraihe (ngā huruhuru angiangi), te whakanui i te laser, me te whakanui i te poihau me te wāhanga whakanui-mua 1mm te diameter me ngā stent whakarewa.

2. Ngā Pūnaha tirotiro kanohi me te diameter o te 3.5-4.0 mm:

I roto i te ariā, he pai tēnei mō ngā tamariki neke atu i te kotahi tau te pakeke. Mā tōna hongere mahi 2.0 mm ka taea ngā tikanga pēnei i te electrocoagulation, te cryoablation, te transbronchial needle aspiration (TBNA), te transbronchial lung biopsy (TBLB), te whakawhanui i te poihau, me te whakatakotoranga stent.

He pūwero te Olympus BF-MP290F, he whānui o waho ko te 3.5 mm me te awa 1.7 mm. He whānui o waho o te pito: 3.0 mm (wāhanga whakauru ≈ 3.5 mm); he whānui o roto o te awa: 1.7 mm. Ka taea te haere o ngā pūwero koiora 1.5 mm, ngā pūwero ultrasound 1.4 mm, me ngā paraihe 1.0 mm. Kia mahara, kāore e taea e ngā pūwero koiora 2.0 mm te uru ki tēnei awa. He rite tonu ngā whakaritenga a ngā waitohu ā-rohe pērā i a Shixin. Ko ngā pūwero koiora o te whakatupuranga hou a Fujifilm, ko te EB-530P me te EB-530S, he pūwero tino angiangi me te whānui o waho ko te 3.5 mm me te awa 1.2 mm te whānui o roto. He pai ēnei mō te tirotiro me te wawaotanga o ngā whara pūkahukahu ā-taha i roto i ngā tautuhinga tamariki me ngā pakeke. He hototahi ēnei ki ngā paraihe cytology 1.0 mm, ngā pūwero koiora 1.1 mm, me ngā pūwero tinana ke 1.2 mm.

3. Ngā pūkahukahu he whānui 4.9 mm, neke atu rānei:

He pai mō ngā tamariki 8 tau te pakeke, neke atu rānei, e 35 kg te taumaha, neke atu rānei. Mā te hongere mahi 2.0 mm ka taea ngā mahi pēnei i te electrocoagulation, te cryoablation, te transbronchial needle aspiration (TBNA), te transbronchial lung biopsy (TBLB), te whakawhanui poihau, me te whakatakotoranga stent. He nui ake i te 2 mm te hongere mahi a ētahi bronchoscopes, ā, he pai ake mō ngā mahi wawao.

Diameter

4. Ngā Take Motuhake: Ka taea te whakamahi i ngā bronchoscope tino angiangi me te diameter o waho o te 2.0 mm, 2.2 mm rānei, ā, kāore he hongere mahi hei tirotiro i ngā ara manawa iti o raro o ngā pēpi whānau wawe, ngā pēpi whānau-katoa rānei. He pai hoki ēnei mō ngā whakamātautau ara manawa o ngā pēpi nohinohi he nui te aukati o te ara manawa.

I te poto, me whiriwhiri te tauira tika i runga i te tau o te tūroro, te rahi o te ara manawa, me ngā matea tātaritanga me ngā matea maimoatanga kia angitu ai, kia haumaru ai hoki te tikanga.

Ko ētahi mea hei aro atu i te wā e whiriwhiri ana i tētahi whakaata:

Ahakoa e tika ana ngā pūkahukahu angiangi 4.0mm te whānui o waho mō ngā tamariki neke atu i te 1 tau te pakeke, i te wā e whakamahia ana, he uaua ki te toro atu ki te pūkahukahu hohonu o ngā tamariki 1-2 tau te pakeke ngā pūkahukahu angiangi 4.0mm te whānui. Nō reira, mō ngā tamariki kei raro iho i te 1 tau te pakeke, 1-2 tau te pakeke, ā, he iti iho i te 15kg te taumaha, ko ngā pūkahukahu angiangi 2.8mm, 3.0mm rānei te whānui o waho te whānui e whakamahia whānuitia ana mō ngā mahi o ia rā.

Mō ngā tamariki 3-5 tau te pakeke, ā, 15kg-20kg te taumaha, ka taea e koe te whiriwhiri i tētahi whakaata angiangi he 3.0mm te whānui o waho, he whakaata rānei he 4.2mm te whānui. Mēnā ka whakaatuhia e te whakaahua he nui te wāhi o te atelectasis, ā, tera pea ka āraia te mono huware, me whakamahi tuatahi i tētahi whakaata he 4.2mm te whānui, he kaha ake te kukume, ā, ka taea te momi. Ā muri ake nei, ka taea te whakamahi i tētahi whakaata angiangi he 3.0mm te whānui mō te keri hohonu me te tūhura. Mēnā ka whakaarohia te PCD, te PBB, me ētahi atu, ā, he ngawari ki ngā tamariki te puta he nui ngā waikura, me whiriwhiri hoki i tētahi whakaata matotoru he 4.2mm te whānui, he ngāwari ki te kukume. Hei tāpiri, ka taea hoki te whakamahi i tētahi whakaata he 3.5mm te whānui.

Mō ngā tamariki e 5 tau te pakeke, neke atu rānei, ā, e 20 kg te taumaha, neke atu rānei, he pai ake te whakamahi i tētahi bronchoscope 4.2 mm te whānui o waho. Mā te hongere kuku 2.0 mm ka taea te whakahaere me te momi.

Heoi anō, me whiriwhiri he bronchoscope angiangi ake he 2.8/3.0 mm te whānui o waho i roto i ēnei āhuatanga e whai ake nei:

① Te whakapūngao ara manawa ā-tinana:

• Te whakatōtōtanga o te ara manawa i te whānautanga, i muri rānei i te pokanga, te tracheobronchomalacia, te whakatōtōtanga o te pēhanga o waho rānei. • Te whānui o roto o te wāhanga hauā iti, o te wāhanga hauā whaiti rawa rānei < 5 mm.

② Te whara o te manawa, te pupuhi rānei i ngā wā tata nei

• Te pupuhi o te korokoro/korokoro iti i muri i te werohanga, ngā weranga o te pito o te trachea, te whara rānei o te manawa.

③ Te stridor nui, te uaua rānei o te manawa

• Te laryngotracheobronchitis whakapeka, te status asthmaticus kino rānei, me iti noa te riri.

④ Ara ihu me ngā pūaha ihu whaiti

• He nui te piko o te tomokanga o te ihu, o te turbinate rānei o raro i te wā e whakaurua ana te ihu, ā, ka kore e taea te haere i roto i te endoscope 4.2 mm me te kore whara.

⑤ Te hiahia kia uru ki roto i te pūkahukahu taha (taumata 8, teitei ake rānei).
• I ētahi wā o te niumōnia Mycoplasma kino me te atelectasis, mēnā kāore tonu e taea te whakaora i te atelectasis e ngā horoinga alveolar bronchoscopic maha i te wā whakapeka, me whakamahi pea he endoscope pai hei keri hohonu ki roto i te bronchoscope distal hei tūhura me te rongoā i ngā puru huware iti, hohonu. • Mēnā he whakapae mō te aukati bronchial (BOB), he hua o te niumōnia kino, ka taea te whakamahi i te endoscope pai hei keri hohonu ki roto i ngā peka iti me ngā peka iti o te wāhanga pukahukahu e pāngia ana. • Mēnā he atresia bronchial whānau, me keri hohonu ki te endoscope pai mō te atresia bronchial hohonu. • Hei tāpiri, ko ētahi whara taha horapa (pērā i te toto alveolar horapa me ngā pona taha) me whakamahi he endoscope pai ake.

⑥ Ngā hapa o te kaki, o te maxillofacial rānei e pā tahi ana

• Ngā mate micromandibular, craniofacial rānei (pēnei i te mate Pierre-Robin) e whakawhāiti ana i te wāhi oro-pharyngeal.

⑦ He poto te wā mahi, me tirotiro noa i te taatai

• Ko te BAL anake, te paraihe, te koiora māmā rānei e hiahiatia ana; kāore e hiahiatia he taputapu nunui, ā, ka taea e te endoscope angiangi te whakaiti i te mumura.

⑧ Te aroturukitanga i muri i te pokanga

• Te tirotiro pūkahukahu pakari, te whakawhanuitanga poihau rānei i ngā wā tata nei hei whakaiti i te whara tuarua o te kiriuhi mucous.

I te poto:

"Te ngoikore o te puku, te pupuhi, te poto o te manawa, te iti o ngā ihu, te hohonu o te taha, te āhua rerekē, te poto o te wā tirotiro, me te whakaoranga i muri i te pokanga"—mēnā kei te kitea tētahi o ēnei āhuatanga, huri ki tētahi endoscope angiangi 2.8–3.0 mm.

4. Mō ngā tamariki neke atu i te 8 tau te pakeke, ā, neke atu i te 35 kg te taumaha, ka taea te whiriwhiri i tētahi endoscope he 4.9 mm te whānui o waho, nui atu rānei. Heoi, mō te bronchoscopy auau, he iti ake te whakapataritari o ngā endoscope angiangi ki te tūroro, ā, ka whakaiti i te tūponotanga o ngā raruraru mēnā kāore e hiahiatia he wawaotanga motuhake.

5. Ko te tauira EBUS tamariki matua a Fujifilm i tēnei wā ko te EB-530US. Ko ōna whakatakotoranga matua koia ēnei: te whānui o waho tawhiti: 6.7 mm, te whānui o waho o te ngongo whakauru: 6.3 mm, te hongere mahi: 2.0 mm, te roa mahi: 610 mm, me te roa katoa: 880 mm. Te pakeke me te taumaha e taunakitia ana: Nā te whānui tawhiti o te endoscope he 6.7 mm, e taunakitia ana mō ngā tamariki 12 tau te pakeke, neke atu rānei, neke atu rānei i te 40 kg te taumaha.

Karu Ārai Ataata Olympus Ultrasonic: (1) EBUS Raina (BF-UC190F Series): ≥12 tau te pakeke, ≥40 kg. (2) EBUS Porowhita + Whakaata Tino Angiangi (BF-MP290F Series): ≥6 tau te pakeke, ≥20 kg; mō ngā tamariki nohinohi, me whakaiti ake te whānui o te mata tirotiro me te whakaata.

He kupu whakataki ki ngā momo bronchoscopy

E ai ki te hanganga me ngā mātāpono whakaahua, ka whakarōpūtia ngā Bronchoscopes ki ngā kāwai e whai ake nei:

Ngā pūkahukahu muka-whatu

Ngā pūkahukahu hiko

Ngā bronchoscope whakakotahi

Ngā pūkahukahu aunoa-fluorescence

Ngā pūkahukahu ultrasonik

……

Pūnaha tirotiro muka whatu:

Pūnaha tirotiro hiko:

Pūnaha tirotiro pūhui:

Ētahi atu pūkahukahu:

Ngā Pūnaha Rongoā Ultrasound (EBUS): Ko tētahi pūnaha ultrasound kua whakauruhia ki te pito o mua o te endoscope hiko e mōhiotia ana ko te "airway B-ultrasound." Ka taea e ia te uru ki te pakitara o te ara manawa, ā, ka kitea mārama ngā kōpū lymph mediastinal, ngā oko toto, me ngā pukupuku i waho o te trachea. He tino pai mō te whakatau i ngā tūroro mate pukupuku pūkahukahu. Mā te werohanga i raro i te ultrasound, ka taea te tiki tika i ngā tauira kōpū lymph mediastinal hei whakatau mēnā kua horapa te pukupuku, ā, ka ārai pea i te whara o te thoracotomy tuku iho. Kua wehea te EBUS ki te "EBUS nui" hei tirotiro i ngā whara huri noa i ngā ara manawa nui me te "EBUS iti" (me te pūnaha taha) hei tirotiro i ngā whara o te pūkahukahu taha. E whakaatu mārama ana te "EBUS nui" i te whanaungatanga i waenga i ngā oko toto, ngā kōpū lymph, me ngā whara e noho ana i te wāhi i roto i te mediastinum i waho o ngā ara manawa. Ka taea hoki te mimiti ngira transbronchial tika ki roto i te whara i raro i te aroturukitanga wā-tūturu, ka ārai pai i te kino ki ngā oko toto nui me ngā hanganga ngākau e karapoti ana, ka whakapai ake i te haumaru me te tika. He iti ake te tinana o te "EBUS iti", e āhei ai te kite mārama i ngā whara o te pūkahukahu ki ngā wāhi kāore e taea e ngā bronchoscopes tuku iho te toro atu. Ina whakamahia me te uhi whakauru, ka taea te tango tauira tika ake.

Pūnaha tirotiro irahiko: Ka whakakotahi te pūnaha tirotiro irahiko ā-pūnaha irahiko tuku iho me te pūnaha tirotiro irahiko pūtau me te hangarau mōhiohio hei tautuhi i ngā whara mā te whakamahi i ngā rerekētanga irahiko i waenga i ngā pūtau pukupuku me ngā pūtau noa. I raro i ngā roangaru mārama motuhake, ka tukuna e ngā whara o mua i te matepukupuku, ngā pukupuku rānei i te wā tōmua he irahiko ahurei e rerekē ana i te tae o te kiko noa. Mā tēnei ka āwhina i ngā tākuta ki te kite i ngā whara iti e uaua ana ki te kite mā te endoscopy tuku iho, ā, ka whakapai ake i te tere tātaritanga wawe o te matepukupuku pūkahukahu.

Ngā pūkahukahu angiangi rawa:He tikanga endoscopic ngāwari ake ngā bronchoscopes tino angiangi, he iti ake te diameter (te tikanga <3.0 mm). Ko te nuinga o te wā ka whakamahia mō te tirotiro tika, te rongoā rānei i ngā rohe o te pukahukahu tawhiti. Ko tō rātou painga matua ko te kaha ki te tiro i ngā bronchi subsegmental i raro i te taumata 7, e āhei ai te tirotiro taipitopito ake i ngā whara ngawari. Ka taea e rātou te toro atu ki ngā bronchi iti e uaua ana ki te toro atu ki ngā bronchoscopes tuku iho, ka whakapai ake i te tere o te kitenga o ngā whara wawe me te whakaiti i ngā whara pokanga.He paionia matatau i roto i te "whakatere me te karetao":te tūhura i te "rohe kāore anō kia matara" o ngā pukahukahu.

He rite te tirotiro pūkahukahu whakatere aukume hiko (ENB) ki te whakauru i tētahi tirotiro pūkahukahu ki tētahi GPS. I mua i te pokanga, ka hangaia anō he tauira pūkahukahu 3D mā te whakamahi i ngā matawai CT. I te wā o te pokanga, ka ārahihia e te hangarau tūnga aukume te endoscope mā roto i ngā manga pūkahukahu uaua, ka aro tika ki ngā pona pūkahukahu iti e torutoru noa iho te whānui (pēnei i ngā pona karāhe whenua i raro i te 5 mm) mō te koiora, te tango rānei i te pona.

Pūnaha tirotiro roro āwhina-rorohiko: Ka whakahaerehia te endoscope e te ringa rorohiko e whakahaerehia ana e te tākuta i te papatohu, ka whakakore i te awe o te wiri o te ringaringa, ka tutuki ai te tika o te tūnga. Ka taea e te pito o te endoscope te huri i te 360 tohu, ka taea ai te whakatere ngāwari i roto i ngā ara pūnaha uaua. He tino pai mō te whakahaere tika i roto i ngā pokanga pukahukahu uaua, ā, kua whai pānga nui kē ki ngā mara o te koiora pona pukahukahu iti me te ablation.

Ko ētahi o ngā bronchoscopes ā-whare: