In our clinical work in respiratory department, we often encounter the situation that some patients who have cough, sputum or blood in sputum repeatedly because of respiratory diseases, and have been transferred to various hospitals and undergone various examinations, mainly chest imaging such as X-ray chest film, chest CT or even MRI, etc., have failed to get a clear diagnosis or have been treated blindly because the diagnosis is unknown. There is no doubt that medical imaging (X-ray chest film, chest CT, MIR, etc.) plays a very important role in the diagnosis of respiratory diseases, and is also a routine test that patients are willing to accept because it is painless and convenient for them. However, if we rely too much on imaging examinations for some diseases, we may lose the best time for treatment due to delayed diagnosis, which brings great mental harm and economic burden to patients and their families. The bendable bronchoscope (including fiberoptic bronchoscope and electronic bronchoscope) is more and more widely used as a clinical practical technology in the diagnosis and treatment of respiratory diseases, and is valued and favored by respiratory clinicians, especially for certain respiratory diseases with unknown diagnosis, which has a unique and irreplaceable role in helping the diagnosis of diseases.
I. What is fiberoptic bronchoscopy?
Fiberoptic bronchoscope is a bendable bronchial endoscope developed based on the development of fiberoptic conduction. 1966 Japanese scientists finally produced the world’s first real fiberoptic bronchoscope after unremitting efforts and applied it in clinical practice. It can be directly inserted into the trachea and bronchus through the oral or nasal cavity to observe the mucous membrane and lumen in the trachea and bronchus. It makes full use of the special advantages of the light transmission system of fiber optics, such as strong light conduction performance under bendable conditions, little interference from the outside world, and flexible devices, etc. It has the following advantages: (1) the mirror body is soft and can be bent, and can be examined when the patient is in natural supine or sitting position. (2) The outer diameter of the mirror body is thin, according to the different requirements of examination and treatment, the modern fibrinoscope has formed a series of models according to its different uses, and its straight through only 3-6 mm, can be bent through the oral cavity or directly inserted into the trachea by the nasal cavity, the patient’s pain is small, easy to tolerate. (3) Expanded indications, due to the convenient operation, easy to grasp, safer, less complications, etc., the scope of its examination and treatment has been continuously expanded. It has been widely used in the diagnosis and treatment of respiratory system diseases. At present, with the rapid development of electronic technology, fiberoptic bronchoscopy has been replaced by electronic bronchoscopy with more convenient operation and clearer images in many hospitals.
Second, who are suitable for fibronectomy?
Generally speaking, as long as there is no contraindication to fibronectomy, fibronectomy should be considered when the following conditions occur
1. Unexplained hemoptysis or blood in sputum.
2. Unexplained cough and sputum that are difficult to explain by smoking or bronchitis, or qualitative changes in the original cough and sputum, especially in middle-aged and elderly people.
3.X-ray chest film shows limited emphysema, obstructive pneumonia or pulmonary atelectasis, etc., suggesting bronchial obstruction, and physical examination has limited dry monk’s snail dumplings
4.Lung cancer is suspected by clinical symptoms or X-ray chest examination, but lacks pathological basis.
5.Sputum examination cytology examination reveals suspected cancer cells, and no lesion is found in the lung on X-ray chest radiograph.
6.Patients with hoarseness of unknown origin.
7.Difficult to diagnose or unexplained bronchial or pulmonary diseases or diffuse lung diseases that require cytological and bacteriological examination by fiberoptic bronchoscopy, bronchial lung biopsy, brush examination or flushing, etc.
8.Inexplicable sputum in which tuberculosis antacid bacilli are not found or suspected to be tuberculosis complicated by lung cancer.
9.In order to clarify the degree and scope of bronchial dilatation and provide a basis for clinical treatment, selective bronchography is performed using fiberoptic bronchoscopy.
10.Use fiberoptic bronchoscope to treat respiratory system diseases, such as aspiration of respiratory secretions, treatment of certain causes of pulmonary atelectasis, hemoptysis, etc.; attraction, irrigation, drainage of pulmonary abscess; understanding the scope of certain lesions, provide a basis for surgery to determine the mode of surgery, and at the same time can evaluate the effectiveness of disease treatment, etc.
Who can’t do fiberoptic bronchoscopy?
Fiberoptic bronchoscopy cannot be done for patients with the following conditions.
1.Patients with very poor general condition and very weak constitution.
2.Severe impairment of lung function and obvious difficulty in breathing.
3.Severe heart disease, cardiac insufficiency or frequent angina pectoris, and obvious heart rhythm disturbance.
4.Severe hypertension.
5.Aortic aneurysm with risk of rupture.
6.In case of acute asthma attack, it is necessary to suspend the procedure.
7.Abnormalities in bleeding and coagulation mechanisms.
Therefore, the physician must carefully understand the patient’s medical history and do the necessary physical examination before doing fiberoptic bronchoscopy for the patient, and understand and check the routine tests required by the fiberoptic bronchoscopy application form, such as platelets, bleeding and clotting time, electrocardiogram (listed as routine for those over 45 years old), etc.; for those with respiratory insufficiency, blood gas analysis or pulmonary function test should be done, and the necessary chest X-ray should be taken, and the relevant sputum Bacteriological and cytological examination, etc. This is used to estimate the condition, analyze the clinical diagnosis, and carry out the examination purposefully to prevent accidents and complications during the examination. For older patients with heart disease, fiberoptic bronchoscopy is usually performed under cardiac monitoring and necessary emergency preparations are made.
Preparation of patients for fiberoptic bronchoscopy
1. Patients should fast 4-6 hours before surgery. Fasting 2 hours before surgery.
2. Half an hour before surgery, inject atropine 0.5 mg, valium 10 mg, and if necessary, inject dulcolax 50 mg intramuscularly. Preoperatively, use 1~2% dicaine or 2~4% lidocaine or 10% nufocaine for mucosal surface anesthesia.
3.Before the examination, briefly explain to the patient the operation process of fibrinoscopy to reduce the patient’s nervousness and eliminate concerns so that they can actively cooperate with the examination.
4. During the examination, the patient is placed in a supine position, with the shoulders slightly padded, the head squared, slightly tilted back, and the nostrils facing upward. In this position, the patient’s muscles are relaxed, more comfortable, and can prevent syncope, more suitable for the elderly, frail, nervous people examination.
5. Avoid coughing during the operation, and when the endoscope enters the vocal cavity, the patient should inhale deeply and not be nervous.
6. After the operation, the patient should rest and observe for half an hour before leaving the examination room. Postoperative nasopharyngeal discomfort, pain, hoarseness, fever, blood in the sputum, etc. may occur, which can be self-cured within a short time or a few days.
7, 2-3 hours after the operation before eating, the beginning of semi-liquid is appropriate, pay attention to oral hygiene, available boric acid solution or furacilin solution gargle.
8. If biopsy is done, attention should be paid to whether there is pneumothorax or active bleeding, and consultation should be made at any time if there is any change so that timely treatment can be obtained. If the examination takes a long time, coughing more frequently or hemoptysis, sedatives and hemostatic agents are available and antibiotics can be given to prevent respiratory and pulmonary infections.
V. What is the role of fibrinoscopy in the diagnosis of respiratory diseases?
For the general public, it is necessary to understand the role of fibrinoscopy in the diagnosis of respiratory diseases, because only by understanding it can we actively cooperate with physicians to conduct the necessary examinations and avoid blindly seeking medical treatment when seeking medical consultation due to illness.
1. Diagnosis of lung cancer suspected by clinical manifestations or X-ray examination: due to the large visualization range of fibronectomy, combined with biopsy, brush examination and bronchoalveolar lavage, the positive rate of lung cancer diagnosis can be achieved. It makes the positive rate of lung cancer diagnosis significantly higher, and is an important tool for early diagnosis of lung cancer. It has the irreplaceable role and advantages of conventional X-ray chest film and CT.
2.Examination of unexplained hemoptysis: For many patients with hemoptysis, fibrinoscopy can not only determine the source (site) of hemoptysis, but also clearly diagnose the cause of hemoptysis. For example, lung cancer, tuberculosis, acute and chronic pneumonia or abnormal lung and bronchial development. It provides a strong basis for determining the treatment plan.
3. For unexplained cough: the patient’s cough symptoms are difficult to explain by smoking or bronchitis, or the original cough has changed in nature during the treatment process, especially for middle-aged and elderly people. At this time, early fibrinoscopy can help clarify the cause and help determine the diagnosis so that it can receive timely and reasonable treatment.
4.For patients with bronchial obstructive diseases: bronchial obstruction manifesting as limited emphysema, limited dry Monk’s snail about targeting narrow displays residence obstructive pneumonia or pulmonary atelectasis and other conditions. Fibrinoscopy can not only help to clarify the cause, but also give effective treatment by using fibrinoscopic techniques.
5.For bronchial and pulmonary diseases and some diffuse lung diseases with diagnostic difficulties: manifested as diffuse interstitial lung fibrosis, alveolar protein deposition, etc., bronchial lung biopsy, brushing or flushing, etc., through fibronectomy, cytology and bacteriological examination can help to clarify the diagnosis.
6, for infectious lesions of the lung: infectious diseases of the lung can be diagnosed etiologically through examination. To provide precise evidence for the rational clinical use of antibiotics, and also local treatment by fibrinoscopy can be used to benefit the prognosis of the disease.
7.For bronchial dilatation: selective bronchography mediated by fibrinoscopy can show the site and scope of lesions well to determine whether surgical treatment is available or to provide a basis for the selection of surgical treatment plan. This test is less painful for the patient and can be tolerated by patients with poor lung function and is relatively safe.
In conclusion, with the continuous improvement of the function of fiberoptic bronchoscopy itself and the maturity of its examination technology, its role in the diagnosis and treatment of lung diseases will certainly play an increasingly important role.
What respiratory diseases can be treated by fiberoptic bronchoscopy?
The use of fiberoptic bronchoscopy for the treatment of bronchial luminal lesions is an interventional treatment developed based on the expansion of the function of fiberoptic bronchoscopy itself and the development of the corresponding auxiliary treatment instruments based on the progress of high technology. The clinical application of this technology has made it possible to treat some respiratory diseases that could only be treated by open surgery in the past without open surgery through endobronchial treatment via ciliofibroscopy. Moreover, the scope of treatment is expanding. The following is a brief introduction of some common respiratory diseases treated by transbronchoscopy.
1.Foreign body removal: Large foreign bodies are difficult to remove with fibronectomy, and metal rigid bronchoscopes are generally used. However, smaller foreign bodies or foreign bodies located at more distal sites, such as melons, metallic and bony fragments, etc. are helpful to be removed with a fibronectomy.
2, treatment of hemoptysis: patients with hemoptysis undergoing fibrinoscopy can not only find out the site and cause of bleeding, but also carry out local treatment. If there is a small amount of bleeding, hemostatic drugs can be injected directly into the bronchus of the bleeding lung segment through the fibrinoscope. For large amounts of hemoptysis, a catheter with a balloon can be placed in the bleeding bronchus through the fibrinoscope, and the balloon can be inflated to stop the hemorrhage by filling and compressing. In addition, microwave coagulation therapy can also be used to achieve the purpose of hemostasis.
3, the treatment of pulmonary atelectasis: the causes of pulmonary atelectasis are various, in the following cases can be treated with fibrinoscopy such as: in patients with severe lung infection, there are often patients because of the inability to cough, sputum obstruction in the bronchial cavity resulting in pulmonary atelectasis; or due to pain after thoracic or abdominal surgery, etc. affect the patient coughing sputum, resulting in post-surgical pulmonary atelectasis; or due to hemoptysis and blood clot obstruction in the bronchial cavity resulting in Pulmonary atelectasis, etc. In this case, the use of therapeutic fibrinoscopy can effectively remove the sputum or blood clots obstructing the bronchial cavity, which can have an immediate effect. In addition, our “high-pressure balloon dilatation airway angioplasty” and “microwave coagulation therapy” have also achieved excellent results in the treatment of benign bronchial stenosis-induced pulmonary atelectasis. Patients are spared the pain of open-heart surgery to remove lung lobes.
4.Treatment of refractory pulmonary tuberculosis: In recent years, we have developed an effective way to treat refractory pulmonary tuberculosis by directly delivering anti-tuberculosis drugs into the cavity formed by pulmonary tuberculosis under the mediation of fibrinoscopy. The endobronchial tuberculosis can be treated by direct removal of necrotic tissues and hyperplastic granulation by microwave or high-frequency electric knife or laser mediated by fibrinoscopy, which can relieve or cure the symptoms of bronchial stenosis caused by these reasons.
5.Treatment of tumors in the airway lumen: With the continuous development of fibrinoscopy technology and improvement of equipment in recent years, benign tumors in the tracheobronchial lumen can be removed directly by fibrinoscopic interventional technology. For malignant tumors in the airway lumen, laser, freezing, microwave, electrocoagulation and other treatments or direct local injection of chemotherapeutic drugs or sclerosing agents can be performed to stop or slow down the development of tumors in the airway.
The above briefly introduces the application of fiberoptic bronchoscopy in respiratory diseases, but it is much more than that. Here, we just want to make you have a general understanding of fiberoptic bronchoscopy through these introductions and eliminate patients’ heart barriers to this effective treatment tool. At the same time, we remind you that when you or your family members are suffering from respiratory diseases with unknown diagnosis or poor treatment results, you should think about the possible need for fiberoptic bronchoscopy in order to clarify the diagnosis.