支氣管鏡的基本操作培訓(xùn)課件

1、支氣管鏡的基本操作支氣管鏡的基本操作 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2支氣管鏡的基本操作 支氣管鏡的適應(yīng)癥，禁忌癥2支氣管鏡的基本操作支氣管鏡的適應(yīng)癥 3支氣管鏡的基本操作支氣管鏡的適應(yīng)癥 3支氣管鏡的基本操作診斷方面 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4支氣管鏡的基本操作診斷方面 不明原因的咯血，慢性咳嗽，聲音嘶啞，局限性哮鳴音4治療方面取出支氣管異物某些肺不張，肺膿瘍等咯血治

2、療引導(dǎo)氣管插管支氣管鏡下治療5支氣管鏡的基本操作治療方面取出支氣管異物5支氣管鏡的基本操作 支氣管鏡的禁忌癥6支氣管鏡的基本操作 支氣管鏡的禁忌癥6支氣管鏡的基本操作 活動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脈瘤全身情況極度衰竭嚴(yán)重的上腔靜脈阻塞綜合征7支氣管鏡的基本操作 活動性大出血7支氣管鏡的基本操作 支氣管鏡術(shù)前準(zhǔn)備8支氣管鏡的基本操作 支氣管鏡術(shù)前準(zhǔn)備8支氣管鏡的基本操作術(shù)前檢查了解病史、測量血壓及心肺體檢胸片或胸部CT檢查出、凝血時間、血小板記數(shù)乙肝兩對半ECG檢查血氣分析9支氣管鏡的

3、基本操作術(shù)前檢查了解病史、測量血壓及心肺體檢9支氣管鏡的基本操作患者準(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小時術(shù)前30分鐘肌注安定和阿托品有異齒術(shù)前摘下10支氣管鏡的基本操作患者準(zhǔn)備向患者講明檢查目的、意義、配合方法10支氣管鏡的基 氣管支氣管的 解剖結(jié)構(gòu)11支氣管鏡的基本操作 氣管支氣管的 解剖結(jié)構(gòu)11支氣12支氣管鏡的基本操作12支氣管鏡的基本操作氣 管上段固定于喉部，下段與主支氣管相連接。 氣管由1520個軟骨環(huán)構(gòu)成，成人氣管橫徑1820mm，長度1013cm，氣管分叉角度5565。 氣管前有甲狀腺，后與食道相鄰。13支氣管鏡的基本操作氣 管上段固定于喉部，下段與主支氣

4、管相連接。13支氣管鏡主支氣管右主支氣管 短而粗，平均長度25mm，直徑1115mm。左主支氣管 細(xì)而長,平均長度50mm,直徑911mm。14支氣管鏡的基本操作主支氣管右主支氣管14支氣管鏡的基本操作右側(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820mm，直徑8mm右中葉支氣管 長度1020mm,直徑7mm右下葉支氣管 長度9mm,直徑7mm15支氣管鏡的基本操作右側(cè)葉支氣管右上葉支氣管15支氣管鏡的基本操作左側(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。16支氣管鏡的基本操作左側(cè)葉

5、支氣管左上葉支氣管16支氣管鏡的基本操作支氣管鏡操作方法 17支氣管鏡的基本操作支氣管鏡操作方法 17支氣管鏡的基本操作18支氣管鏡的基本操作18支氣管鏡的基本操作19支氣管鏡的基本操作19支氣管鏡的基本操作20支氣管鏡的基本操作20支氣管鏡的基本操作21支氣管鏡的基本操作21支氣管鏡的基本操作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22支氣管鏡的基本操作支氣管分支命名右肺左肺上葉B1尖段上葉上葉

6、分支B1+2尖后段Group 1 Exercises23支氣管鏡的基本操作Group 1 Exercises23支氣管鏡的基本操作Step 1: nose to larynxThe scope is advanced from the nose to the larynx .This step includes local anesthesia24支氣管鏡的基本操作Step 1: nose to larynxThe scopStep 2: larynx to subglottisFrom the larynx the trachea is entered to the subglottic a

7、rea.If from the head: once the vocal cords are passed the scope is slightly flexed downwards.If from the front: once the vocal cords are passed the scope is slightly flexed upwards.25支氣管鏡的基本操作Step 2: larynx to subglottisFrStep 3: Follow the curve to the carina The Trachea is not a “straight pipe”;It

8、 deviates posteriorly and slightly to the right when approaching the main carina.26支氣管鏡的基本操作Step 3: Follow the curve to thStep 4a: Carina to left main bronchusFrom the neutral position the LMB is entered just by twisting the wrist to the left and advancing for 1 -2 cm.27支氣管鏡的基本操作Step 4a: Carina to l

9、eft main bStep 4b: Carina to right main bronchusFrom the neutral position the RMB is entered just by twisting the wrist to the right and advancing the scope for 1 -2 cm28支氣管鏡的基本操作Step 4b: Carina to right main From the neutral position the left and right main bronchi are entered alternatively just by

10、 twisting the wrist and advancing the scope for few cm.Step 4c: Left-right-neutral 29支氣管鏡的基本操作From the neutral position the Step 5a: Down-up-left main bronchusThe scope is slowly advanced the pulled back up the LMB while always keeping it in the middle of the airway lumen.30支氣管鏡的基本操作Step 5a: Down-up

11、-left main bro支氣管鏡的基本操作培訓(xùn)課件Group 2 Exercises32支氣管鏡的基本操作Group 2 Exercises32支氣管鏡的基本操作Step 6a: Left main to left upper lobe bronchusFrom the LMB the scope is advanced to the entrance of the LUL bronchus.33支氣管鏡的基本操作Step 6a: Left main to left uppStep 6b: Left main to left lower lobe bronchusThe scope is

12、advanced down the LMB to the entrance of the LLL bronchus.34支氣管鏡的基本操作Step 6b: Left main to left lowStep 6c: Right main to right upper lobe bronchusThe scope is advanced down the RMB then with the wrist twisted 60 degrees from midline the scope is flexed up to the entrance of RUL.35支氣管鏡的基本操作Step 6c:

13、Right main to right uStep 6d: Right main to bronchus intermediusFrom the carina advance the scope down the RMB to the distal bronchus intermedius and visualize the entrance to RB456 and the basal pyramid.36支氣管鏡的基本操作Step 6d: Right main to bronchuStep 6e: Right main to right lower lobe bronchusAdvance

14、 the scope from the carina to the entrance of the RLL while always keeping it in the midline.37支氣管鏡的基本操作Step 6e: Right main to right lGroup 3 Exercises38支氣管鏡的基本操作Group 3 Exercises38支氣管鏡的基本操作Step 7a: Left upper lobe uno dosFrom the carina, the scope is advanced to LUL entrance; there, just by thumb m

15、ovement, the lingula and upper division bronchus are visualized.39支氣管鏡的基本操作Step 7a: Left upper lobe uno dStep 7b: Left before five six (LB 456)From the LMB, the lingula is entered, then the scope is pulled back into the distal LMB and the scope is advanced into the superior segment of the LLL.! Wris

16、t movements are “in the mirror”40支氣管鏡的基本操作Step 7b: Left before five six Step 7c: Left B6-8,9,10With the scope at the LLL bronchus entrance, the superior segment is entered, then alternately, the antero, lateral and postero-basal segments of the LLL are entered.41支氣管鏡的基本操作Step 7c: Left B6-8,9,10With

17、thStep 7d: Right upper lobe uno-dos-tresFrom the RMB the scope is advanced and flexed up into the RUL bronchus where just by wrist and thumb movements the three segments are visualized; then the scope is withdrawn to the main carina.42支氣管鏡的基本操作Step 7d: Right upper lobe uno-Step 7e: Right before five

18、 six (RB 4,5,6)From the distal bronchus intermedius, the RML and superior segment are entered alternatively; ! Wrist movements are “in the mirror”.43支氣管鏡的基本操作Step 7e: Right before five sixStep 7f: Right medial basal (RB7) (d”Artagnan)From the distal bronchus intermedius the scope is advanced and the medio-basal segment is entered.44支氣管鏡的基本操作Step 7f: Right medial basal (RStep 8a: Left lower lobe basal pyramidFrom the entrance of the LLL bronchus go in and out of the 3 basal segments, then withdraw the scope to the carina.45支氣管鏡的基本操作Step 8a: Left lower lobe