Clinically, the two "artifacts" that help respiratory doctors diagnose and treat diseases are chest CT and bronchoscopy. When it comes to tracheoscopy, many people instinctively hesitate or even refuse. After all, a tube so thick, inserted into the throat and trachea, I was afraid to think about it. However, many diseases cannot be diagnosed and treated without tracheoscopy.
What is bronchoscopy?
The principle of bronchoscopy is to insert a thin tube structure with a camera device at the lower end into the lungs through the patient's nasal cavity or mouth, and observe the situation of bronchial lesions through the camera device. Biopsy of suspicious tissue can be taken by bronchoscopic forceps during the examination. It is an important test that provides a basis for the diagnosis and treatment of respiratory diseases. In addition to the common bronchoscopy, ultrasound bronchoscopy can play a greater role in clinical diagnosis.
What is ultrasound bronchoscopy?
An ultrasonic bronchoscope is a device that installs an ultrasound probe at the front of the bronchoscope, which is a combination of bronchoscopic technology and ultrasound technology. Ultrasound bronchoscopy is mainly used for the diagnosis of mediastinal diseases, the staging of lung cancer, the diagnosis of peripheral lung lesions and lung nodules.
Some lesions located in the trachea or outside the bronchi are the "blind spots" of conventional fibronchoscopy, because conventional bronchoscopy can only see lesions located in the trachea and bronchi, and there is often nothing that can be done about lesions outside the tube. Ultrasonic tracheoscopy can locate the specific location of extrabronchial lesions through ultrasound, which can clearly show the relationship between blood vessels, lymph nodes and mass lesions in the outer mediastinum of the airway, and avoid blood vessels under the guidance of color Doppler, obtain cells and tissues at the corresponding sites through needle aspiration and biopsy, completely solve the problem of traditional "blind puncture", effectively avoid damage to surrounding large blood vessels, and improve the accuracy and safety of this technology.
At present, there are two kinds of probes for ultrasound bronchoscopy, a central ultrasound probe, which is equivalent to adding an ultrasound probe in front of the bronchoscope for observing lesions around the large bronchi and mediastinum; the other is an externally shaped probe, which is about 1.8mm in diameter and can be used to observe peripheral lung lesions and extrabronchial structures through the instrumental tract of the tracheoscope.
In the field of lung cancer, ultrasound bronchoscopy has a very important role, the main indications are the staging of lymph nodes in lung cancer patients, the diagnosis of tumors in the lungs, the diagnosis of hilar and/or mediastinal lymphadenopathy of unexplained pulmonary and/or mediastinal lymphadenopathy, and the diagnosis of mediastinal tumors. In addition, current studies have shown that compared with CT, ultrasonic bronchoscopy can effectively distinguish whether the tracheal wall is tumor infiltration or tumor compression, and can accurately determine the degree of tracheal involvement. Ultrasound bronchoscopy also drains lymph nodes with enlarged and necrotic mediastinum and hilars, thereby reducing symptoms and pressure on the airways and relieving patients with dyspnea.
Since its development in 2002, endoscopic transbronchial needle aspiration biopsy (EBUS-TBNA) has been recommended by the National Comprehensive Cancer Network (NCCN) and the American College of Thoracic Physicians (ACCP) Lung Cancer Guidelines as an important tool for preoperative evaluation of lung cancer, providing a new standard for the staging of the mediastinum of lung cancer. Compared with mediastinoscopy, ultrasonic tracheoscopy does not require endotracheal intubation, is minimally invasive, safe, and easier to operate.