158进修心得报告.ppt

Interventional Pulmonology Lahey Clinic進修心得報告 謝義山 胸腔外科主治醫師 Lahey Clinic Burlington Massachusetts March 29- April 1,2006 Agenda Diagnostic Bronchoscopy TBNA Autofluorescence Bronchoscopy Navigational Bronchoscopy Agenda Therapeutic Bronchoscopy Ablative therapy Laser Bronchoscopy Electrocautery APC Cryotherapy Displacement Therapy Rigid Bronchoscopy Balloon Dilatation Stent Silicon Metallic stent Therapeutic Bronchoscopy for emphysema PDT Brachytherapy Agenda:Invasive Pulmonology Rigid Bronchoscopy Percutaneous dilated tracheostomy Medical Thoracoscopy Current Indication for Rigid Bronchoscopy Diagnostic Deep and large quantitative biopsy Photographic documentation Pediatric bronchoscopy Therapeutic Massive hemoptysis: airway control and assessment Tumor ablation / foreign body retrieval Laser therapy Airway dilatation / “core out” of tumor Airway stenting Cryotherapy (RB/FB) Electrocautery (RB/FB) Benefit of RB Airway control / ventilation Large working channel Improved airway visualization Large biopsy size Absence of coughing and unwanted motion Timely multi-modality intervention Limitation of RB Limited availability Access to only the more central airways Percutaneous Tracheostomy Procedure: Safe and quick Cost: Controversal 不須外科及麻醉科 減少等待時間 減少ICU stay Contra-indication: Obesity Coagulopathy Anatomic Barrier: prominent goiter or tumor Pediatric patient High PEEP/FiO2 requirement Emergent airway ? Quick airway at TC menbrane Medical Thoracoscopy Mini-VATS in simple diagnosis and treatment procedure Indication: 覺得光是sono-guide不夠 而給外科開刀又太over 的情形 有indication進行pleural biopsy 及pig tail/ chest tube drainge 就有 indication 不要選看起來就太粘黏 multiple loculation Medical Thoracoscopy Procedure: Local anesthesia, with/without minimal sedation Create Pneumothorax Insertion of trocar and thoracoscpy Traditional VATS instrument Newly Thoracoscopy (Olympus) Collection fluid and take biopsy to interesting region Chest tube replacement Whole procedure is quick and safe Be