支气管镜的基本操作培训课件

1、支气管镜的基本操作支气管镜的基本操作 支气管镜的适应症，禁忌症支气管镜术前的准备工作气管-支气管的解剖结构支气管镜的基本操作方法2支气管镜的基本操作 支气管镜的适应症，禁忌症2支气管镜的基本操作支气管镜的适应症 3支气管镜的基本操作支气管镜的适应症 3支气管镜的基本操作诊断方面 不明原因的咯血，慢性咳嗽，声音嘶哑，局限性哮鸣音支气管感染性疾病的病因学诊断肺炎胸片或CT检查异常已诊断肺癌术前检查，指导手术范围及估计预后食管-支气管瘘的确诊胸部外伤，怀疑有支气管裂伤和断裂4支气管镜的基本操作诊断方面 不明原因的咯血，慢性咳嗽，声音嘶哑，局限性哮鸣音4治疗方面取出支气管异物某些肺不张，肺脓疡等咯血治

2、疗引导气管插管支气管镜下治疗5支气管镜的基本操作治疗方面取出支气管异物5支气管镜的基本操作 支气管镜的禁忌症6支气管镜的基本操作 支气管镜的禁忌症6支气管镜的基本操作 活动性大出血不能纠正的出血倾向尿毒症，活检易出血者严重肺动脉高压，活检易出血者严重心、肺功能障碍严重心律失常新近发生心肌梗死或心绞痛疑有主动脉瘤全身情况极度衰竭严重的上腔静脉阻塞综合征7支气管镜的基本操作 活动性大出血7支气管镜的基本操作 支气管镜术前准备8支气管镜的基本操作 支气管镜术前准备8支气管镜的基本操作术前检查了解病史、测量血压及心肺体检胸片或胸部CT检查出、凝血时间、血小板记数乙肝两对半ECG检查血气分析9支气管镜的

3、基本操作术前检查了解病史、测量血压及心肺体检9支气管镜的基本操作患者准备向患者讲明检查目的、意义、配合方法术前签字术前禁食6小时术前30分钟肌注安定和阿托品有异齿术前摘下10支气管镜的基本操作患者准备向患者讲明检查目的、意义、配合方法10支气管镜的基 气管支气管的 解剖结构11支气管镜的基本操作 气管支气管的 解剖结构11支气12支气管镜的基本操作12支气管镜的基本操作气 管上段固定于喉部，下段与主支气管相连接。 气管由1520个软骨环构成，成人气管横径1820mm，长度1013cm，气管分叉角度5565。 气管前有甲状腺，后与食道相邻。13支气管镜的基本操作气 管上段固定于喉部，下段与主支气

4、管相连接。13支气管镜主支气管右主支气管 短而粗，平均长度25mm，直径1115mm。左主支气管 细而长,平均长度50mm,直径911mm。14支气管镜的基本操作主支气管右主支气管14支气管镜的基本操作右侧叶支气管右上叶支气管 长度9mm，直径8mm右中间段支气管 长度820mm，直径8mm右中叶支气管 长度1020mm,直径7mm右下叶支气管 长度9mm,直径7mm15支气管镜的基本操作右侧叶支气管右上叶支气管15支气管镜的基本操作左侧叶支气管左上叶支气管 距左上叶支气管开口约5mm处，向前下处方发出舌段。左下叶支气管 距左下叶支气管开口约5mm处，向后发出背段。16支气管镜的基本操作左侧叶

5、支气管左上叶支气管16支气管镜的基本操作支气管镜操作方法 17支气管镜的基本操作支气管镜操作方法 17支气管镜的基本操作18支气管镜的基本操作18支气管镜的基本操作19支气管镜的基本操作19支气管镜的基本操作20支气管镜的基本操作20支气管镜的基本操作21支气管镜的基本操作21支气管镜的基本操作支气管分支命名右肺左肺上叶B1尖段上叶上叶分支B1+2尖后段B2后段B3前段B3前段中叶B4外段舌叶B4上舌段B5内段B5下舌段下叶B6背段下叶B6背段B7内基底段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支气管镜的基本操作支气管分支命名右肺左肺上叶B1尖段上叶上叶

6、分支B1+2尖后段Group 1 Exercises23支气管镜的基本操作Group 1 Exercises23支气管镜的基本操作Step 1: nose to larynxThe scope is advanced from the nose to the larynx .This step includes local anesthesia24支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作Step 5a: Down-up

11、-left main bro支气管镜的基本操作培训课件Group 2 Exercises32支气管镜的基本操作Group 2 Exercises32支气管镜的基本操作Step 6a: Left main to left upper lobe bronchusFrom the LMB the scope is advanced to the entrance of the LUL bronchus.33支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作Step 6e: Right main to right lGroup 3 Exercises38支气管镜的基本操作Group 3 Exercises38支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作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支气管镜的基本操作Step 8a: Left lower lobe