Трахеобронхос­копия

Tracheobronchoscopy is an endoscopic technique for examining the human trachea and bronchi, or rather, their mucous membrane. For this type of diagnosis, a flexible endoscope with a built-in light source is used, which, after being inserted into the lumen of the trachea and bronchus, helps to examine the internal state of the organs. Forceps can be passed through the tunnel of the endoscope to remove foreign bodies that can enter during breathing, as well as to perform a biopsy from pathological areas of the mucous membranes of the respiratory tract.

Tracheobronchoscopy can be upper, when the endoscope is inserted through the mouth and larynx, reaching the bronchi and trachea, or lower, when surgical methods of inserting the endoscope are necessary. In this case, an opening is made in the neck or tracheostomy, through which, in case of obstruction of the upper respiratory tract, air enters the lungs.

Indications and contraindications for the procedure

More often than other doctors, tracheobronchoscopy is prescribed by pulmonologists, oncologists, and phthisiatricians, but sometimes other specialists can also recommend diagnostics. Tracheobronchoscopy can be done in any pulmonology center or in the department at the clinic.

Indications for the appointment of this procedure are the detection and the need to remove various foreign bodies in the bronchi, benign tumors in the trachea, atelectasis of a lobe of the lung or an entire organ, narrowing of the trachea of ​​a congenital nature, bronchiectasis and its diagnosis, tracheoesophageal fistula, abscess, bleeding in the lungs and the need to search their sources, tuberculosis, parasitic pulmonary processes, diverticula, infections in the lungs, severe pneumonia, lung cancer.

Among the main contraindications to the use of tracheobronchoscopy in a patient, doctors include the presence of cardiovascular diseases, for example, past heart attacks, strokes, severe arrhythmias, exacerbated bronchial asthma, acute infectious diseases, ankylosis of the temporomandibular joint, aortic aneurysm, as well as many neuropsychiatric anomalies .

Any tracheobronchoscopy can have serious postoperative complications such as pneumothorax, bleeding, laryngeal edema, and bronchospasm.

Conducting research

To obtain the most accurate data during tracheobronchoscopy, patients should be in a sitting position, less often they can lie down. The specialist sprays an aerosol anesthetic for local anesthesia into the oral cavity.

When diagnosing diseases by tracheobronchoscopy in children, general anesthesia is used for them, since otherwise it is not possible to carry out the procedure.

After anesthesia, the patient:

• an endoscope is inserted through the mouth;
• the root of the tongue is pressed by the apparatus for the visibility of the glottis;
• for a clear localization of the glottis, the patient is asked to talk.

When it is determined, the end of the endoscope begins to be immersed in the region of the larynx. The patient breathes deeply and evenly so that the glottis is constantly in an expanded state. After the larynx, the endoscope reaches the trachea. For inspection of the bronchi, the patient’s head turns each time in the direction opposite to the considered bronchus, for example, when examining the left bronchus, the head should turn to the right and vice versa.

If mucus is required to be removed from the trachea or bronchi, then an aspirator specially designed for this procedure is used, and if foreign objects need to be removed from these organs, forceps are used. When visualizing any changes in the mucous membrane, the specialist immediately performs a biopsy of these areas in order to send them to the laboratory for histological examination.

Before carrying out the diagnostic manipulation of tracheobronchoscopy, it is not recommended to eat food.

It is very rarely possible to conduct an examination after a meal, but this complicates the doctor’s work and causes a lot of inconvenience to the patient, since a gag reflex often occurs, which does not allow a full start of the examination, as a result of which it is necessary to additionally perform gastric lavage.

Tracheobronchoscopy results

For a whole day after tracheobronchoscopy, the patient may be haunted by various ailments. Due to irritation of the mucous membrane by the endoscope, persistent pain in the throat may occur. The most common complications of tracheobronchoscopy are mechanical damage to the trachea or bronchial walls by the endoscope, and bleeding may also occur if a biopsy was performed during the diagnosis.

If a person’s health is normal, then the doctor during the examination can see through the endoscope a normal smooth light pink trachea with a yellowish tint, with a well-defined vascular pattern and visible tracheal rings and gaps. In the bronchi, the vascular pattern is also palpably visualized. During periods of breathing, the walls of the trachea and bronchi move.

In the presence of an inflammatory process in the bronchi, their mucous reddens, well-separated mucous or purulent discharges are found. With the development of atrophy, the specialist sees during tracheobronchoscopy an increase in folding and thinning of the mucous membrane, and also observes the expansion of the lumen of the bronchi.

In the presence of malignant neoplasms localized around the bronchi, the lumen of the bronchus is deformed, the wall of the bronchus loses its mobility during breathing, and the vascular pattern disappears completely or partially. In the presence of foreign bodies, they are visualized as formations, due to which the lumen of the bronchus is not visible.

It is important to remember that if foreign bodies are detected during tracheobronchoscopy, they may be removed during the procedure.

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