ABSTRACT
La ecografía endobronquial (EBUS: endobronchial ultrasound) combina en un endoscopio flexible dos sistemas de imagen: uno óptico, idéntico al de los broncoscopios convencionales y una sonda de ecografía. Existen dos tipos de ecobroncoscopios: lineal/sectorial y radial. El primero disponible fue el ecobroncoscopio radial, pero en la actualidad el más utilizado es el lineal. Las principales indicaciones de la ecobroncoscopia radial se refieren al estudio de lesiones pulmonares periféricas y a la exploración de la pared traqueobronquial para ver si existe infiltración neoplásica o no. Su principal desventaja es que no permite la toma de muestras en tiempo real. Sus complicaciones son las mismas que una broncoscopia convencional con reali-zación de biopsias transbronquiales siendo, por tanto, una técnica segura y muy eficaz. La ecobroncoscopia lineal tiene como principal indicación la estadificación mediastínica en pacientes con sospecha o previamente diagnosticados de cáncer de pulmón primario o metastático, aunque también se utiliza para la evaluación mediastínica en otras patologías. El uso de Doppler color permite la diferenciación de estructuras vasculares, lo que hace la técnica más segura. Su principal ventaja respecto a la ecobroncoscopia radial es que permite la punción en tiempo real. Es una técnica segura, cuya tasa de complicaciones es muy baja (1,5%)
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Subject(s)
Humans , Male , Female , Bronchoscopy/instrumentation , Bronchoscopy/methods , Bronchoscopy , Bronchoscopes/classification , Bronchoscopes , Carcinoma in Situ , Solitary Pulmonary Nodule , Ultrasonography/methods , Bronchial Provocation Tests/instrumentation , Sarcoidosis , Sarcoidosis, Pulmonary , Electrocardiography/instrumentation , Electrocardiography/methods , Pathology/methodsABSTRACT
Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.
Subject(s)
Airway Obstruction , Bronchoscopes/classification , Bronchoscopy , Laser Therapy/methods , Lung Neoplasms , Postoperative Complications , Quality of Life , Adult , Aged , Airway Obstruction/etiology , Airway Obstruction/surgery , Bronchi/pathology , Bronchi/surgery , Bronchoscopy/adverse effects , Bronchoscopy/instrumentation , Bronchoscopy/methods , Female , Humans , Laser Therapy/adverse effects , Lung Neoplasms/complications , Lung Neoplasms/pathology , Lung Neoplasms/psychology , Lung Neoplasms/surgery , Male , Middle Aged , Palliative Care/methods , Patient Selection , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/therapy , Preoperative Care/methods , Stents , Treatment OutcomeABSTRACT
OBJECTIVE: Tracheobronchial foreign bodies (FBs) are frequently present in adults. This study reports our experience with the managements of FB and FB-related complications using flexible bronchoscopy. METHODS: We retrospectively reviewed the adult patients with FBs treated between 2001 and 2011 in China. The demographic and endoscopic data were collected and analyzed. RESULTS: A total of 200 adult patients (136 men and 64 women) with an average age of 51 years were analyzed. The most common FBs included bones (51.0%), nut shells (15.0%), food boluses (7.0%), plastic toys or pen caps (6.5%). After FB aspiration occurred, only 11.0% were diagnosed within three days, while more than half of the patients (58.0%) delayed the diagnosis by more than one month. The incidence of FB-related complications was 79.5%, including granulation formation (76.5%), obstructive pneumonia (22.0%), hemorrhage (14.5%), atelectasis (10.0%) and endobronchial stenotic scarring (8.0%). In 96.5% of the patients, the FBs were successfully removed under flexible bronchoscopy. A total of 53 out of the 153 patients with granulation (34.6%) were managed by argon plasma coagulation (APC) or cryotherapy; two out of the sixteen patients with endobronchial stenotic scars were treated by balloon dilation under flexible bronchoscopy. CONCLUSION: A high incidence of FB-related complications occurs, likely as a result of the long delay between aspiration and diagnosis, a proportion of which require endoscopic intervention. The removal of FBs under flexible bronchoscopy has a high success rate and therefore should be recommended for adults.
Subject(s)
Asian People , Bronchi/surgery , Bronchoscopes/classification , Bronchoscopy/instrumentation , Bronchoscopy/methods , Foreign Bodies/surgery , Trachea/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Argon Plasma Coagulation , China , Cicatrix/therapy , Cryotherapy , Delayed Diagnosis/adverse effects , Female , Granulation Tissue , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
La situación de la broncoscopia pediátrica, gracias a la miniaturización de los fibrobroncoscopios y los esfuerzos docentes de las diferentes Unidades de Neumología Pediátrica, ha experimentado una evolución fulgurante en nuestro país en los últimos años. Sin embargo, esta técnica sigue identificándose casi exclusivamente con la extracción de cuerpos extraños por lo que en este trabajo se realiza una revisión y actualización de las aplicaciones diagnóstico-terapéuticas de la broncoscopia pediátrica(AU)
With smaller miniaturized fiber bronchoscopy available and thanks to continuous research and work a number of pediatric pneumology units have carried out, a revolution in the pediatric fiber bronchoscopy field has taken place in our country in the last few years. However, and despite having a variety of uses, this technique is still strongly and almost exclusively related to foreign body removal. This paper aims to widen the scope of pediatric fiber bronchoscopy indications, by reviewing and updating all the other diagnostic and therapeutic applications this safe and useful tool has(AU)
Subject(s)
Humans , Male , Female , Child , Bronchoscopy/methods , Bronchoscopy , Diagnostic Techniques and Procedures/standards , Diagnostic Techniques and Procedures/trends , Diagnostic Techniques and Procedures , Patient Safety/standards , Bronchoscopes/classification , Bronchoscopes , Conscious Sedation , Bronchoscopes/trends , Bronchoscopes , Intensive Care Units, Pediatric/trendsSubject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bronchoscopy/adverse effects , Bronchoscopy/methods , Bronchoscopy/trends , Bronchoscopes/classification , Biopsy/instrumentation , Biopsy/methods , Hemoptysis/therapy , Bronchoalveolar Lavage/instrumentation , Bronchoalveolar Lavage/methods , Instillation, Drug , Airway Obstruction/therapy , Foreign Bodies/therapy , Pulmonary Atelectasis/etiology , Inhalation/instrumentationABSTRACT
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Subject(s)
Humans , Bronchoscopy/methods , Bronchoscopes/classification , Airway Obstruction/diagnosis , Foreign Bodies , Risk FactorsABSTRACT
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Subject(s)
Humans , Bronchoscopy/methods , Bronchoscopes/classification , Airway Obstruction/diagnosis , Postoperative Complications , Risk Factors , Cryotherapy/methods , Brachytherapy/methods , Phototherapy/methodsABSTRACT
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