Fiberoptic bronchoscopy is a new examination technique that has been applied in the clinic since the 1970s. It is a diagnostic and treatment technique that uses bronchoscopy to directly diagnose and treat tracheal and bronchial diseases through the mouth and throat to the trachea and bronchi. The application of this examination technique has led to great progress in the diagnosis and treatment of lung diseases. It has a wide range of clinical applications, is minimally invasive and has great significance.
Fiberoptic bronchoscopy
I. Indications for bronchoscopy.
(a) There are mainly the following cases that require fiberoptic bronchoscopy
1. Cough of unknown origin, which is difficult to explain by smoking or bronchitis, or the original cough has changed qualitatively, especially in middle-aged and elderly people.
2. Unexplained hemoptysis or blood in sputum. Common causes of hemoptysis include bronchiectasis, lung cancer, endobronchial tuberculosis, pulmonary tuberculosis, bronchitis, lung abscess, sarcoidosis, trauma, pulmonary vascular abnormalities, etc. Fibrinoscopy can identify the cause and also stop the hemorrhage for treatment.
3. wheezing of unknown cause, suggesting localized narrowing of trachea and large bronchus, the cause may be tracheal or bronchial tumor, tuberculosis, foreign body, inflammation, spasm, etc. Fibrinoscopy should be performed as early as possible to confirm the diagnosis.
4. Bronchial obstruction, manifested as restrictive emphysema, obstructive pneumonia or pulmonary atelectasis, etc. The cause of atelectasis is tumor, inflammation, foreign body and other obstruction of the bronchi resulting in atrophy of the corresponding lung tissue, once atelectasis occurs, a fibrinoscopy should be performed as soon as possible to detect the cause.
5.Clinical manifestation or X-ray examination is suspected to be lung cancer.
6.Sputum cytology examination found cancer cells, but no lesion was found in lung imaging examination.
7.Patients with unexplained paralysis of the recurrent laryngeal nerve or phrenic nerve.
8.Difficulty in diagnosing bronchial and pulmonary diseases or diffuse lung diseases of unknown diagnosis, requiring fiberoptic bronchoscopy, bronchial lung biopsy, brush examination or bronchoalveolar lavage, etc., cytology and bacteriological examination.
9.Inexplicable antacid bacilli found in sputum or pulmonary tuberculosis complicated by lung cancer.
10.Assist in selective bronchial iodine oil angiography.
11.Tracheal intubation guided by fibrinoscopy can be performed under local anesthesia with the patient awake, and the pain and discomfort caused by the operation is less.
12.Assist in preoperative staging of lung cancer and deciding the scope of resection. Fibroscopy is used to understand the lesion in the bronchus and the closest distance of the lesion edge from the augmentation to decide the scope of bronchus and lung resection.
13.Application after chest trauma and chest surgery. Fibroscopy can understand the site, scope and severity of tracheal injury, and can also detect complications of surgery and understand the surgical anastomosis.
(B) Bronchoscopy is used to treat.
1.Removal of foreign body in the airway. The foreign body can be removed through the bronchoscope to avoid the pain caused by rigid mirror and surgery to remove foreign body.
2.Clear respiratory secretions. Sputum obstruction of the airway causes ventilation dysfunction and secondary lung infection or aggravates lung infection, fibronectomy can remove airway secretions and take sputum for bacterial culture.
3.Treatment of hemoptysis. High-frequency electric knife can be used to stop the hemorrhage through the fibrinoscope, and catheter balloon can also be used to stop the hemorrhage.
4.Bronchoalveolar lavage treatment. Under general anesthesia, whole lung lavage via bronchoscopy is used to treat acute stage pneumoconiosis, as well as patients with alveolar protein deposition.
5.Local treatment of primary malignant tumors in the airways. Including injection of anti-cancer drugs into the tumor (chemotherapy), intracavitary radiotherapy for lung cancer, laser, high-frequency electric knife, microwave, freezing and other treatments for tumors.
6.Interventional treatment of tracheal and bronchial tuberculosis. Interventional treatment of tracheal and bronchial tuberculosis by injection of anti-TB drugs under fibrinoscopy, application of laser, high-frequency electric knife, microwave, freezing, etc.
7.Other benign airway diseases. Bronchoscopic high-frequency electric knife can treat bronchial stenosis caused by trauma scar, post-surgical endobronchial granuloma, foreign body granuloma, as well as benign tumors and other benign lesions in the tracheobronchus.
8.Treatment of airway stenosis by endotracheal and endobronchial stent placement via fibrinoscopy.
9.For pulmonary infectious diseases, bronchoalveolar lavage and local injection of antibiotics through bronchoscopy are beneficial to the absorption of inflammation.
B. Contraindications of bronchoscopy.
1, the general condition is very poor, the systemic state is extremely debilitated.
2.Severe impairment of lung function, obvious difficulty in breathing and respiratory failure.
3.Severe heart disease, cardiac insufficiency or frequent angina pectoris, obvious heart rhythm disorders.
4.Severe hypertension.
5.Aortic aneurysm at risk of rupture
6.Recent hemoptysis, acute attack of asthma, which needs to be suspended.
7.Patients with abnormal bleeding and coagulation mechanism.
Cautions for bronchoscopy.
Before the examination, the medical history and the necessary physical examination should be taken, and the routine examinations such as platelets, clotting time, electrocardiogram, etc. should be understood and verified; in case of respiratory insufficiency, blood gas analysis or pulmonary function test, chest X-ray, bacteriological and cytological examination of sputum should be done. In order to estimate the condition, analyze the clinical diagnosis and conduct the examination purposefully to prevent accidents and complications during the examination. Patients who are older and have heart disease should be performed under cardiac monitoring and be prepared for necessary first aid. Patients should not be nervous and cooperate actively.
The patient should fast 4 to 6 hours before the operation. Half an hour before surgery, inject 0.5 mg of atropine and 10 mg of Valium intramuscularly. Preoperatively, 2-4% lidocaine is used for mucosal surface anesthesia. The patient is placed in the supine position with the shoulders slightly padded and the head squared, slightly tilted backwards with the nostrils facing upwards. In this position, the patient’s muscles are relaxed and more comfortable, and syncope can be prevented.
Avoid coughing during the operation, and when the bronchoscope enters the voice portal, the patient should inhale deeply and should not strain or hold his breath.
After the operation, the patient should rest and observe before leaving the examination room. Postoperative nasopharyngeal discomfort, pain, hoarseness, fever and blood in sputum may occur, which is not important and can be self-healed within a short time or several days. You can eat only 2 hours after the operation, and it is appropriate to start with semi-liquid, pay attention to oral hygiene, and use boric acid solution or furacilin solution for gargling. If a biopsy is done, attention should be paid to the presence of pneumothorax or active bleeding, and any changes should be seen at any time for timely treatment. If the examination takes a long time, cough more frequently or hemoptysis, sedatives and hemostatic agents are available and antibiotics can be given to prevent respiratory and pulmonary infections.