气管镜检查及介入治疗大全指南解读／适应症／禁忌症／经典图谱／立体图谱／镜下表现／ 治疗.pptVIP

超声支气管内镜（EBUS） 引导下的经支气管针吸引活检（TBNA） EBUS-TBNA 在清晰查看到针头与血管的位置的状态下，使用支气管镜取样淋巴结组织 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. 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 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. 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 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. 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. ! 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 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up into the RUL bronchus where just by wrist and thumb movements the three segments are visualized; then the scope is withdrawn to the main carina.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 7e: Right before five six (RB 4,5,6) From the distal bronchus intermedius, the RML and superior segment are entered