支气管镜的基本操作
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! Wrist movements are “in the mirror”
Step 7c: Left B6-8,9,10
With 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.
Step 7f: Right medial basal (RB7) (d”Artagnan)
From the distal bronchus intermedius the scope is advanced and the mediobasal segment is entered.
Step 8a: Left lower lobe basal pyramid
Step 7e: Right before five six (RB 4,5,6)
From the distal bronchus intermedius, the RML and superior segment are entered alternatively;
! Wrist movements are “in the mirror”.
If from the front: once the vocal cords are passed the scope is slightly flexed upwards.
Step 3: Follow the curve to the carina
The Trachea is not a “straight pipe”;
From the carina advance the scope to the RLL bronchus entrance and then enter the medial-basal segment, pull back and then examine the other three segments of the basal pyramid.
Step 6e: Right main to right lower lobe bronchus
Advance the scope from the carina to the entrance of the RLL while always keeping it in the midline.
Group 3 Exercises
Step 7a: Left upper lobe uno dos
From the carina, the scope is advanced to LUL entrance; there, just by thumb movement, the lingula and upper division bronchus are visualized.
From the entrance of the LLL bronchus go in and out of the 3 basal segments, then withdraw the scope to the carina.
Step 8b: Right lower lobe basal pyramid (D’Artagnan and the three musketeers)
It deviates posteriorly and slightly to the right when approaching the main carina.
Step 4a: Carina to left main bronchus
From the neutral position the LMB is entered just by twisting the wrist to the left and advancing for 1 -2 cm.
右侧叶支气管
右上叶支气管
长度9mm，wenku.baidu.com径8mm
右中间段支气管
长度8－20mm，直径 8mm
右中叶支气管
长度10－20mm,直径 7mm
右下叶支气管
长度9mm,直径7mm
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。
支气管镜的基本操作
方苏榕
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
支气管镜的适应症
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
支气管镜操作方法
支气管分支命名
上叶 中叶 下叶
右肺 B1 B2 B3 B4 B5 B6 B7 B8 B9
B10
尖段 后段 前段 外段 内段 背段 内基底段 前基底段 外基底段
后基底段
左肺
上叶
上叶 分支
B1+2 B3
舌叶 B4 B5 B6
B8
下叶 B9
尖后段
前段
上舌段 下舌段 背段 前基底段
From the larynx the trachea is entered to the subglottic area.
If from the head: once the vocal cords are passed the scope is slightly flexed downwards.
Step 6d: Right main to bronchus intermedius
From the carina advance the scope down the RMB to the distal bronchus intermedius and visualize the entrance to RB456 and the basal pyramid.
Step 7d: Right upper lobe uno-dos-tres
From 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.
Step 5a: Down-up-left main bronchus
The scope is slowly advanced the pulled back up the LMB while always keeping it in the middle of the airway lumen.
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
治疗方面
取出支气管异物 某些肺不张，肺脓疡等 咯血治疗 引导气管插管 支气管镜下治疗
支气管镜的禁忌症
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
外基底段
B10 后基底段
Group 1 Exercises
Step 1: nose to larynx
The scope is advanced from the nose to the larynx .
This step includes local anesthesia
Step 2: larynx to subglottis
Group 2 Exercises
Step 6a: Left main to left upper lobe bronchus
From the LMB the scope is advanced to the entrance of the LUL bronchus.
Step 6b: Left main to left lower lobe bronchus
Step 4b: Carina to right main bronchus
From the neutral position the RMB is entered just by twisting the wrist to the right and advancing the scope for 1 -2 cm
支气管镜术前准备
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
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
气管—支气管的 解剖结构
Step 5b: Down-up right main bronchus
The scope is slowly advanced down the RMB to RLL and pulled back upwards while always keeping it in the middle of the airway lumen.
The scope is advanced down the LMB to the entrance of the LLL bronchus.
Step 6c: Right main to right upper lobe bronchus
The 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.
气管
上段固定于喉部，下段与 主支气管相连接。
气管由15－20个软骨环 构成，成人气管横径18－ 20mm，长度10－13cm ，气管分叉角度55－65°
。 气管前有甲状腺，后与 食道相邻。
主支气管
右主支气管 短而粗，平均长度
25mm，直径11－ 15mm。
左主支气管 细而长,平均长度
50mm,直径9－ 11mm。
Step 4c: Left-right-neutral
From the neutral position the left and right main bronchi are entered alternatively just by twisting the wrist and advancing the scope for few cm.
Step 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.
Step 7c: Left B6-8,9,10
With 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.
Step 7f: Right medial basal (RB7) (d”Artagnan)
From the distal bronchus intermedius the scope is advanced and the mediobasal segment is entered.
Step 8a: Left lower lobe basal pyramid
Step 7e: Right before five six (RB 4,5,6)
From the distal bronchus intermedius, the RML and superior segment are entered alternatively;
! Wrist movements are “in the mirror”.
If from the front: once the vocal cords are passed the scope is slightly flexed upwards.
Step 3: Follow the curve to the carina
The Trachea is not a “straight pipe”;
From the carina advance the scope to the RLL bronchus entrance and then enter the medial-basal segment, pull back and then examine the other three segments of the basal pyramid.
Step 6e: Right main to right lower lobe bronchus
Advance the scope from the carina to the entrance of the RLL while always keeping it in the midline.
Group 3 Exercises
Step 7a: Left upper lobe uno dos
From the carina, the scope is advanced to LUL entrance; there, just by thumb movement, the lingula and upper division bronchus are visualized.
From the entrance of the LLL bronchus go in and out of the 3 basal segments, then withdraw the scope to the carina.
Step 8b: Right lower lobe basal pyramid (D’Artagnan and the three musketeers)
It deviates posteriorly and slightly to the right when approaching the main carina.
Step 4a: Carina to left main bronchus
From the neutral position the LMB is entered just by twisting the wrist to the left and advancing for 1 -2 cm.
右侧叶支气管
右上叶支气管
长度9mm，wenku.baidu.com径8mm
右中间段支气管
长度8－20mm，直径 8mm
右中叶支气管
长度10－20mm,直径 7mm
右下叶支气管
长度9mm,直径7mm
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。
支气管镜的基本操作
方苏榕
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
支气管镜的适应症
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
支气管镜操作方法
支气管分支命名
上叶 中叶 下叶
右肺 B1 B2 B3 B4 B5 B6 B7 B8 B9
B10
尖段 后段 前段 外段 内段 背段 内基底段 前基底段 外基底段
后基底段
左肺
上叶
上叶 分支
B1+2 B3
舌叶 B4 B5 B6
B8
下叶 B9
尖后段
前段
上舌段 下舌段 背段 前基底段
From the larynx the trachea is entered to the subglottic area.
If from the head: once the vocal cords are passed the scope is slightly flexed downwards.
Step 6d: Right main to bronchus intermedius
From the carina advance the scope down the RMB to the distal bronchus intermedius and visualize the entrance to RB456 and the basal pyramid.
Step 7d: Right upper lobe uno-dos-tres
From 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.
Step 5a: Down-up-left main bronchus
The scope is slowly advanced the pulled back up the LMB while always keeping it in the middle of the airway lumen.
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
治疗方面
取出支气管异物 某些肺不张，肺脓疡等 咯血治疗 引导气管插管 支气管镜下治疗
支气管镜的禁忌症
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
外基底段
B10 后基底段
Group 1 Exercises
Step 1: nose to larynx
The scope is advanced from the nose to the larynx .
This step includes local anesthesia
Step 2: larynx to subglottis
Group 2 Exercises
Step 6a: Left main to left upper lobe bronchus
From the LMB the scope is advanced to the entrance of the LUL bronchus.
Step 6b: Left main to left lower lobe bronchus
Step 4b: Carina to right main bronchus
From the neutral position the RMB is entered just by twisting the wrist to the right and advancing the scope for 1 -2 cm
支气管镜术前准备
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
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
气管—支气管的 解剖结构
Step 5b: Down-up right main bronchus
The scope is slowly advanced down the RMB to RLL and pulled back upwards while always keeping it in the middle of the airway lumen.
The scope is advanced down the LMB to the entrance of the LLL bronchus.
Step 6c: Right main to right upper lobe bronchus
The 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.
气管
上段固定于喉部，下段与 主支气管相连接。
气管由15－20个软骨环 构成，成人气管横径18－ 20mm，长度10－13cm ，气管分叉角度55－65°
。 气管前有甲状腺，后与 食道相邻。
主支气管
右主支气管 短而粗，平均长度
25mm，直径11－ 15mm。
左主支气管 细而长,平均长度
50mm,直径9－ 11mm。
Step 4c: Left-right-neutral
From the neutral position the left and right main bronchi are entered alternatively just by twisting the wrist and advancing the scope for few cm.
Step 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.