支氣管鏡的基本操作

支氣管鏡的基本操作方蘇榕當(dāng)前1頁，總共46頁。

支氣管鏡的適應(yīng)癥，禁忌癥支氣管鏡術(shù)前的準(zhǔn)備工作氣管-支氣管的解剖結(jié)構(gòu)支氣管鏡的基本操作方法當(dāng)前2頁，總共46頁。支氣管鏡的適應(yīng)癥

當(dāng)前3頁，總共46頁。診斷方面

不明原因的咯血，慢性咳嗽，聲音嘶啞，局限性哮鳴音支氣管感染性疾病的病因?qū)W診斷肺炎胸片或CT檢查異常已診斷肺癌術(shù)前檢查，指導(dǎo)手術(shù)范圍及估計(jì)預(yù)后食管-支氣管瘺的確診胸部外傷，懷疑有支氣管裂傷和斷裂當(dāng)前4頁，總共46頁。治療方面取出支氣管異物某些肺不張，肺膿瘍等咯血治療引導(dǎo)氣管插管支氣管鏡下治療當(dāng)前5頁，總共46頁。

支氣管鏡的禁忌癥當(dāng)前6頁，總共46頁。

活動(dòng)性大出血不能糾正的出血傾向尿毒癥，活檢易出血者嚴(yán)重肺動(dòng)脈高壓，活檢易出血者嚴(yán)重心、肺功能障礙嚴(yán)重心律失常新近發(fā)生心肌梗死或心絞痛疑有主動(dòng)脈瘤全身情況極度衰竭嚴(yán)重的上腔靜脈阻塞綜合征當(dāng)前7頁，總共46頁。

支氣管鏡術(shù)前準(zhǔn)備當(dāng)前8頁，總共46頁。術(shù)前檢查

了解病史、測(cè)量血壓及心肺體檢胸片或胸部CT檢查出、凝血時(shí)間、血小板記數(shù)乙肝兩對(duì)半ECG檢查血?dú)夥治霎?dāng)前9頁，總共46頁?；颊邷?zhǔn)備

向患者講明檢查目的、意義、配合方法術(shù)前簽字術(shù)前禁食6小時(shí)術(shù)前30分鐘肌注安定和阿托品有異齒術(shù)前摘下

當(dāng)前10頁，總共46頁。

氣管—支氣管的解剖結(jié)構(gòu)當(dāng)前11頁，總共46頁。當(dāng)前12頁，總共46頁。氣管

上段固定于喉部，下段與主支氣管相連接。氣管由15－20個(gè)軟骨環(huán)構(gòu)成，成人氣管橫徑18－20mm，長度10－13cm，氣管分叉角度55－65°。

氣管前有甲狀腺，后與食道相鄰。當(dāng)前13頁，總共46頁。主支氣管

右主支氣管

短而粗，平均長度25mm，直徑11－15mm。左主支氣管

細(xì)而長,平均長度50mm,直徑9－11mm。當(dāng)前14頁，總共46頁。右側(cè)葉支氣管

右上葉支氣管

長度9mm，直徑8mm右中間段支氣管

長度8－20mm，直徑8mm右中葉支氣管

長度10－20mm,直徑7mm右下葉支氣管

長度9mm,直徑7mm當(dāng)前15頁，總共46頁。左側(cè)葉支氣管

左上葉支氣管

距左上葉支氣管開口約5mm處，向前下處方發(fā)出舌段。左下葉支氣管

距左下葉支氣管開口約5mm處，向后發(fā)出背段。當(dāng)前16頁，總共46頁。支氣管鏡操作方法

當(dāng)前17頁，總共46頁。當(dāng)前18頁，總共46頁。當(dāng)前19頁，總共46頁。當(dāng)前20頁，總共46頁。當(dāng)前21頁，總共46頁。支氣管分支命名右肺左肺上葉B1尖段上葉上葉分支B1+2尖后段B2后段B3前段B3前段中葉B4外段舌葉B4上舌段B5內(nèi)段B5下舌段下葉B6背段下葉B6背段B7內(nèi)基底段B8前基底段B8前基底段B9外基底段B9外基底段B10后基底段B10后基底段當(dāng)前22頁，總共46頁。Group1Exercises當(dāng)前23頁，總共46頁。Step1:nosetolarynxThescopeisadvancedfromthenosetothelarynx.Thisstepincludeslocalanesthesia當(dāng)前24頁，總共46頁。Step2:larynxtosubglottisFromthelarynxthetracheaisenteredtothesubglotticarea.Iffromthehead:oncethevocalcordsarepassedthescopeisslightlyflexeddownwards.Iffromthefront:oncethevocalcordsarepassedthescopeisslightlyflexedupwards.當(dāng)前25頁，總共46頁。Step3:FollowthecurvetothecarinaTheTracheaisnota“straightpipe”;Itdeviatesposteriorlyandslightlytotherightwhenapproachingthemaincarina.當(dāng)前26頁，總共46頁。Step4a:CarinatoleftmainbronchusFromtheneutralpositiontheLMBisenteredjustbytwistingthewristtotheleftandadvancingfor1-2cm.當(dāng)前27頁，總共46頁。Step4b:CarinatorightmainbronchusFromtheneutralpositiontheRMBisenteredjustbytwistingthewristtotherightandadvancingthescopefor1-2cm當(dāng)前28頁，總共46頁。Fromtheneutralpositiontheleftandrightmainbronchiareenteredalternativelyjustbytwistingthewristandadvancingthescopeforfewcm.Step4c:Left-right-neutral當(dāng)前29頁，總共46頁。Step5a:Down-up-leftmainbronchusThescopeisslowlyadvancedthepulledbackuptheLMBwhilealwayskeepingitinthemiddleoftheairwaylumen.當(dāng)前30頁，總共46頁。Step5b:Down-uprightmainbronchusThescopeisslowlyadvanceddowntheRMBtoRLLandpulledbackupwardswhilealwayskeepingitinthemiddleoftheairwaylumen.當(dāng)前31頁，總共46頁。Group2Exercises當(dāng)前32頁，總共46頁。Step6a:LeftmaintoleftupperlobebronchusFromtheLMBthescopeisadvancedtotheentranceoftheLULbronchus.當(dāng)前33頁，總共46頁。Step6b:LeftmaintoleftlowerlobebronchusThescopeisadvanceddowntheLMBtotheentranceoftheLLLbronchus.當(dāng)前34頁，總共46頁。Step6c:RightmaintorightupperlobebronchusThescopeisadvanceddowntheRMBthenwiththewristtwisted60degreesfrommidlinethescopeisflexeduptotheentranceofRUL.當(dāng)前35頁，總共46頁。Step6d:RightmaintobronchusintermediusFromthecarinaadvancethescopedowntheRMBtothedistalbronchusintermediusandvisualizetheentrancetoRB456andthebasalpyramid.當(dāng)前36頁，總共46頁。Step6e:RightmaintorightlowerlobebronchusAdvancethescopefromthecarinatotheentranceoftheRLLwhilealwayskeepingitinthemidline.當(dāng)前37頁，總共46頁。Group3Exercises當(dāng)前38頁，總共46頁。Step7a:LeftupperlobeunodosFromthecarina,thescopeisadvancedtoLULentrance;there,justbythumbmovement,thelingulaandupperdivisionbronchusarevisualized.當(dāng)前39頁，總共46頁。Step7b:Leftbeforefivesix(LB456)FromtheLMB,thelingulaisentered,thenthescopeispulledbackintothedistalLMBandthescopeisadvancedintothesuperiorsegmentoftheLLL.!Wristmovementsare“inthemirror”當(dāng)前40頁，總共46頁。Step7c:LeftB6-8,9,10WiththescopeattheLLLbronchusentrance,thesuperiorsegmentisentered,thenalternately,theantero,lateralandpostero-basalsegmentsoftheLLLareentered.當(dāng)前41頁，總共46頁。Step7d:Rightupperlobeuno-dos-tresFromtheRMBthescopeisadvancedandflexedupintotheRULbronchuswherejustbywristandthumbmovementsthethreesegmentsarevisualized;thenthescopeiswithdrawntothemaincarina.當(dāng)前42頁，總共46頁。Step7e:Rightbeforefivesix(RB4,5,6)Fromthedistalbronchusintermedius,theRMLandsuperiorsegmentareenteredalternatively;!Wristmovementsare“inthemirror”.當(dāng)前43頁，總共46頁。Step7f:Rightmedialbasal(RB7)(d”Artagnan)Fromthedistalbronchusintermediusthescopeisadvancedandthemedio-basalsegmentisentered.當(dāng)前44頁，總共46頁。Step8a:LeftlowerlobebasalpyramidFromtheentranceoftheLLLbronchusgoinandoutofthe3basalsegments,thenwithdrawthescopetothecarina.當(dāng)前45頁，總共46頁