bronqoskopiis SesaZleblobebi.

daviT Wyonia

tuberkulozisa da filtvisdaavadebaTa erovnuli centri

15 dekemberi 2015

bronqoskopiis istoria

bronqoskopiis mamad iTvleba germaneli laringologi gustav kiliani (Gustav Killian), romelmac 1897 wels, pirvelad medicinis istoriaSi, amoiRo ucxosxeuli traqeidan. am wels daibada bronqoskopia.

imdroindeli gulmkerdisqirurgia jer ar iyoganviTarebuli. lobeqtomiisqirurgiuli teqnika dainergabrunis da lilientalis (Brunnand Lilienthal) mier 1910 wlisSemdeg, xolo pnevmoneqtomiisteqnika dainerga 1930 wlisSendeg nisenis, kameron haitisda grehemis (Nissen, Cameron Haight, and Graham) mier. gustav kilianigaxda imdenad popularuli, rom igi 1907 wels miiwviesamerikis SeerTebul StatebSida mas vaSingtonSi piradadSexvda amerikis prezidentiTeodor ruzvelti.

For this particular case neither there is stent nor tracheoplexy.If the pt is affording, only thing what could be tried is lung transplantation.We have had pts with excessive dynamic collapse who have approved with Ltx. It would cost 500-600,000 USD for a bilateral lung transplant in Cleveland. He willhave to stay in Cleveland for approximately 12-18 months.

sul gakeTda 68 bronqoskopia. maT Soris:38 zestandartulifibrobronqoskopia, 1 zestandartulirigidulibronqoskopia, 1 bronqoskopia zogadinarkoziT. 17 noembers gakeTda 8 bronqoskopia, 26 noembers gakeTda 6 bronqoskopia. 14 SemTxveva simsivnis.

554 11/2amb surgulaZe murTazi 54 Cr

555 11/2amb 9610CigilaSvili marine 60 e.b.(C) I

556 11/2saoperacio 1472Saverdiani artur 25 e.b.s.

557 11/3II Terapia 1479TeqaZe Tornike 18 e.b.(k) I

558 11/3saoperacio 1478kuxalaSvili jambuli 30 e.b.s.

559 11/3amb 10342mamedova qaklik 34 Cr

560 11/4qirurgia 1481nikolaiSvili Tea 32 TB

561 11/4saoperacio 1475kilanava zurab 36 e.b.s.

562 11/4IV Terapia 1483muSarbaZe uSangi 20 e.b.(k) II

563 11/5saoperacio 1496kvinikaZe zurabi 61 marjvena mTavari bronqis postoperaciuli takvi

564 11/5amb 10556bolqvaZe aslani 53 Cr

565 11/5amb 10544nazarevi olegi 25 e.b.(C) I

566 11/5amb 10555mamedovi vagif 57 Cr

567 11/6amb 10441uTaliSvili zaza 44 TB, naw.cvl.

568 11/6IV Terapia 1499silagaZe nikoloz 63 marcxena mTavari bronqis obturacia sisxlis koltiT

569 11/6amb 10577beriaSvili lamara 63 kataraluri laringiti, traqeo-bronqiti

570 11/6saoperacio 1482gabrielovi ivane 59 e.b.s.

571 11/9amb 10662orexovi viqtor 57 sisxlmdeni marjvena z/w bronqi

572 11/9saoperacio 1512zaaliSvili irakli 48 e.b.s.

573 11/9amb 10605jafariZe zurab 56 Cr

574 11/9saoperacio 1513kereseliZe mariami 24 e.b.s.

575 11/10saoperacio 1508bolqvaZe aslani 53 marcxena mTavari bronqis postoperaciuli takvi

576 11/11II Terapia 1524gogilaSvili giorgi 48 e.b.(C) I

577 11/11II Terapia 1511SavaZe arCili 34 e.b.(k) II

578 11/12amb 10784avaliSvili grigoli 69 Cr

579 11/12saoperacio 1527gogiSvili valeri 52 marcxena mTavari bronqis postoperaciuli takvi

580 11/12IV Terapia 1534menTesaSvili naTela 60 TB, naw.cvl.

581 11/17amb 5554besalaSvili badri 43 uSedego

582 11/17II Terapia 1539gergedava avTo 60 e.b.(k) II

583 11/17II Terapia 1541lomiZe nanuli 54 e.b.(k) I

584 11/17II Terapia 1550murvaniZe vaxtangi 35 e.b.(C) I

585 11/17saoperacio 1542CogovaZe aleqsandre 55 e.b.s.

586 11/17IV Terapia 1540miqelaZe goderZi 67 Cr

587 11/17amb 4440pleSakovi vladimer 65 e.b.(k) I

588 11/17saoperacio 1547jiqiZe Salva 23 e.b.s.

589 11/18bavSvTa 1546ruxaZe avTandili 17 e.b.(k) II

590 11/18amb 5554besalaSvili badri 43 e.b.(C) I

591 11/18saoperacio 1552tiguv zelimxani 52 intubacia

592 11/18amb 10928wiTelauri qristine 62 e.b.(C) I

593 11/18IV Terapia 1551ZabuniZe Tea 35 bronqo-plevraluri fistula

594 11/18/15saoperacio 1562sisauri nugzari 64 marjvena z/wilovani bronqis bronqoblokacia

595 11/19amb 10969wiklauri merab 64 Cr

596 11/19II Terapia 1560CixraZe tarieli 50 e.b.(C) I

597 11/19amb 15338mamulaZe soso 50 e.b.(C) I

598 11/19amb 1267elbaqiZe megi 68 e.b.(C) II

599 11/19II Terapia 1549niniaSvili gia 51 TB, naw.cvl.

600 11/19IV Terapia 1558maWaraSvili sofio 21 TB

601 11/20saoperacio 1574sulTaiSvili nino 54 Cr

602 11/20reanimacia 1561cabutaSvili elene 78 sisxlmdeni traqea

603 11/24amb 11064janibegaSvili daviTi 68 Cr

604 11/24amb 10950birCaZe nato 25 e.b.(C) II

605 11/24II Terapia 1576ninua Tamaz 73 sisxlmdeni Suawilovani bronqis B5 segmenturi bronqi

606 11/24amb 11097svanize fridoni 59 Cr

607 11/25II Terapia 1582korZaia dimitri 51 e.b.(C) II

608 11/25amb 7933baiaSvili evgenia 77 e.b.(C) II

609 11/25II Terapia 1579ServaSiZe meri 65 e.b.(k) II

610 11/26amb 11209CitaSvili vladimer 58 naw.cvl.

611 11/26saoperacio 1585varSaniZe qeTino 22 e.b.s.

612 11/26amb 2551papaSvili guguli 75 Cr

613 11/26II Terapia 1584mWedliSvili zurab 45 eroziuli endobronqiti

614 11/26IV Terapia 1594gogolaZe zurabi 25 e.b.(C) II

615 11/26saoperacio 1598odiSaria zurabi 27 e.b.s.

616 11/27qirurgia 1578kvaracxelia rozeni 27 uSedego

617 11/27amb 2327talaxaZe jemali 69 e.b.(C) II

618 11/27amb 11293migriauli Tamaz 65 Cr

619 11/30amb 11336msxalaZe valiko 54 Cr

620 11/30amb 11314tabaRua nino 54 Cr

621 11/30amb 11355gogaSvili ana 63 e.b.(k) I

bronqoskopiebis statistika

niSandoblivia, rom bronqoskopiis miRwevebi saqarTveloSi dakavSirebuliatuberkulozisa da filtvebis daavadebaTa erovnul centrTan. am centrSi keTdebayvelaze meti raodenobiT bronqoskopiuli manipulacia saqarTvelos masStabiT, rogorcdrekadi, aseve xisti bronqoskopebiT. bronqoskopiebis wliuri raodenoba meryeobs 1000-is farglebSi. es raodenoba aris sakmaod maRali postsabWoTa qveynebis doneze. magaliTad q. moskovis tuberkulozis centralur samecniero kvleviT institutSi(Центральныйнаучно-исследовательский институттуберкулеза РАМН), 2014 w monacemebiT, bronqoskopiebis wliuri raodenoba igivea (http://www.cniitramn.ru/docs2/kldo/oe/). evropis da amerikis wamyvan pulmonologiur centrebSi bronqoskopiebis wliuri raodenoba bevradmetia. aSS-Si wliurad keTdeba daax. 500 000 bronqoskopia (Journal of Thoracic Disease, Vol 6, Suppl 4 October 2014). evrogaerTianebis wevr 19qveyanaSi 2012 wels Catarebulibronqoskopiebis raodenoba iyo 890 000, yvelaze meti maT Soris germaniaSi, sadac 100 000 mosaxleze gaangariSebiT gakeTda 400 bronqoskopiaze meti (European Union (EU) statistics (Eurostat) related to diseases of the respiratory system, February 2015). samwuxarod saqarTveloSi aseTistatistikuri monacemebi ar arsebos, magram, Tu vivaraudebT, rom Cveni centris garda, mTeli saqarTvelos masStabiT keTdeba damatebiT igive raodenoba, anu jamSi 2000 bronqoskopia, maSin, bolo aRweris mixedviT 100 000 mosaxleze gamodis 50-mde bronqoskopia, rac TiTqmis 10-jer naklebia evrostatis monacemebze. es sxvaobamiuTiTebs, rom saTanado materialur-teqnikuri bazis mqone trening-centris amoqmedebiTda Sesabamisi ZalisxmeviT Cvens winaSea intervenciuli bronqoskopiis da Sesabamisadpulmonologiis ganviTarebis didi perspeqtivebi.

absoluturi winaaRmdegCvenebebi fibrobronqoskopias ar aqvs. SedarebiTiwinaaRmdegCvenebebia mZime xarisxis bronqoobstruqcia, refraqteruli hipoqsemia, arastabiluri hemodinamikuri statusi, arakoreqtirebadi koagulopaTia da hemoragiulidiaTezi, antigoagulantebis miReba, (ix. Semdegi slaidi), gansakuTrebiT maSin, rocasaWiroa biofsiis aReba. procedura ar keTdeba mSrali sakvebis miRebidan 6-8 saaTis ganmavlobaSi da Txierisakvebis miRebidan 2-4 saaTis ganmavlobaSi. bronqoskopiis winaaRmdegCvenebaa pacientis kategoriuli winaaRmdegoba. proceduramde pacients detalurad unda aexsnas misi mniSvneloba da mosalodneligarTulebebi. yvela pacienti Relavs samedicino proceduris win, gansakuTrebiT maSin, Tu is pirvelad utardeba. am dros mniSvnelovania iseTi detalebi, rogorcpacientisTvis aparatis mcire zomebis demonstrireba (mag. distalur boloze TiTismideba), yuradRebis gamaxvileba proceduris xanmokle mimdinareobaze, imis axsna, rom procedura umtkivneuloa (tkivilis receptorebi aris plevraSi da ara filtvebSi), da rom gulisrevis SegrZneba da xvela male gaivlis saanesTezio saSualebis moqmedebiT. pacienti unda gaecnos informirebul Tanxmobas da xeli moaweros mas. istoria yvela gamokvlevebiT! gulmkerdis Ro-grafia da (an) gulmkerdis CT! alergia lidokainze! arteriuli wneva! informacia biofsiis Taobaze!

pacientis momzadebabronqoskopiisaTvis

ყველა ბრონქოსკოპიავარფარინი

1

dabali riski

1. gulis sarqvlis metalisprotezi aortis poziciaSiQ2. gulis qsenotranslpanturisarqveli

3. winagulovani fibrilacia

4. 3 Tveze meti venuriTromboemboliis Semdeg

varfarinis Sewyveta bronqoskopiamde 5 dRiT adre

1. INR-is Semowmeba, davrwmundeT, rom >1,5

2. gavagrZeloT varfarini bronqoskopiis dRis saRamos daniSnuli doziT

3. gavimeoroT INR 1 kviris Semdeg

2

maRali riski1. gulis sarqvlis metalis

protezi parkuWis poziciaSi

2. gulis sarqvlis protezida winagulovani fibrilacia

3. winagulovani fibrilaciada mitraluri stenozi

4. 3 Tveze meti venuriTromboemboliis Semdeg

5. Trombofiluri sindromi

varfarinis Sewyveta bronqoskopiamde 5 dRiT adre

1. heparinis dawyeba varfarinis Sewyvetidan 2 dRis Semdeg

2. heparinis gamotoveba proceduris dRes

3. gavagrZeloT varfarini bronqoskopiis dRis saRamos daniSnuli doziT

4. heparinis gagrZeleba INR-is daregulirebamde

პლავიქსი

3

dabali riski

1. gulis iSemiuri daavadebakoronaruli stentirebisstentirebis gareSe

2. cerebrovaskularulidavadeba

3. periferiulisisxlZarRvebis daavadeba

plaviqsis Sewyveta bronqoskopiamde 7 dRiT adre

1. gagrZeldes aspirini, Tu aris daniSnuli

2. Tu ar aris daniSnuli, dainiSnos aspirini, sanam plaviqsis miReba aris Sewyvetili

4

maRali riski

1. koronaruli arteriisstentebi

kardiologTan SeTanxmebiT iqnas ganxiluli plaviqsis Sewyveta

bronqoskopiamde 7 dRiT adre im SemTxvevaSi, Tu:

1. 12 Tveze metia gasuli wamliT dafaruli koronaruli stentis Cadgmidan

2. 1 Tveze metia gasuli daufaravi metalis stentis Cadgmidan

3. gagrZeldes aspirinis miReba

bronqebis okluzia

paralonis Rrubeli, spirali, fibrinis webo, cianakrilis webo, vercxlis nitrati, autoqsovili, silikonis blokatorebi da a.S.

bronqebis sanaTuris daxSobis cnobili meTodebia:

bolo dros sul ufro xSirad gamoiyenebasarqvlovani blokatorebi. maTi moqmedebis principia filtvis dazianebul ubanSi samkurnalohipoventilaciis da ateleqtazis Seqmna destruqciisRrus da blokirebuli bronqis drenaJuli funqciisSenarCunebiT.

Endobronchial Watanabe Spigot (EWS),

Emphasys endobronchial valves (EBV).

Occlutech Figulla ASD N device

MedLung

MedLung-is agebuleba

sarqveli Sedgeba adamianis organizmisaTvis indiferentuli rezinis narevisgan da warmoadgens Rru cilindrs. sarqvlis Sida sanaTuri erTi mxridan mrgvalia (1), meore mxridan warmodgenilia Txeli elastiuri sarqveliT (5), romelic ikeceba Warbi garegani wnevis zemoqmedebiT. gareTa zedapiris 2/3 warmoadgens Txeli radialuri frTebi (4) bronqis sanaTurSi misi fiqsaciisavis.

sarqveli yendeba rogorc rigiduli, aseve fibrobronqoskopiT, aris sxvadasxva zomis da bronqis sanaTurs unda aRematebodes 1,5-jer.

sarqvlovani bronqoblokaciis yvelaze xSiri Cvenebebia:

filtvis tuberkulozi;

plevris empiema narCeni RruTi da bronqoplevraluri xvrelmiliT;

filtvis mwvave abscesi garTulebuli sisxldeniTda piopnevmoToraqsiT;

filtvis kibo garTulebuli sisxldeniT;

filtvis emfizema;

filtvis kista;

xangrZlivad mimdinare spontanuri pnevmoToraqsi.

SedarebiT ukuCvenebebswarmoadgens:

1. Cirqovani endobronqiti;

2. bronqebis eqspiratoruli stenozi.

MedLung-iT mkurnalobis Sedegebi

sarqvlovani bronqoblokacia Cautarda 648 avadmyofs, maTgan:

58 SemTxvevaSi filtvebidan sisxldena;

52-postoperaciuli bronqoplevraluri xvrelmilebi;

63-rezistentuli tuberkulozi;

danarCeni-filtvebis destruqciuli tub-zis formebis sxvadasxva SemTxvevaSi.

А. В. Левин, Е. А. Цеймах, П. Е. Зимонин

Применение клапанной бронхоблокации при осложненном туберкулезе легких (пособие для врачей). — Барнаул, 2008. — 24 стр.

filtvebidan sisxldena

filtvebidan sisxldenis dros 111 avadmyofidan 58-s (ZiriTadi jgufi) gaukeTda sarqvlovani bronqoblokacia, 53-s (sakontrolo jgufi) gaukeTda bronqis droebiTi okluzia paralonis obturatoriT.

ZiriTad jgufSi bronqis okluziis xangrZlivoba iyo 224,3+-95,2, xolo maqsimaluri 515 dRe.

sakontrolo jgufSi Sesabamisad 9,3+-6,4 maqsimaluri 30 dRe.

filtvebidan sisxldena

ZiriTadi jgufi sakontr. jgufi

Sesadarebeli parametrebi raodenoba % raodenoba %

obturaciuli Cirqovani endobronqiti

7 12,1 34 64,2

hemoaspiraciuli pnevmonia 3 5,2 17 32

sisxldenis recidivi 2 3,4 8 15,1

dadebiTi Ro dinamika 40 69 8 15,1

sasicocxlo CvenebiT operacia 2 3,4 16 30,2

baqteriagamoyofis Sewyveta 37 63,8 3 5,7

bronqoplevraluri xvrelmilebi

gaanalizda filtvebis destruqciuli tuberkulozis gamo operirebuli 110 avadmyofis mkurnalobis Sedegebi.

ZiriTad jgufSi iyo 52 av-i, romelTac utardebodaT mkurnaloba sarqvlovani bronqoblokatorebiT.

sakontrolo JgufSi 58 av-s bronqis okluzia ukeTdeboda antibiotikebiani paralonis RrublebiT.

orive jgufis yvela av-s utardeboda postrezeqciuli empiemis Rrus punqcia da drenireba, aqtiuri aspiracia yoveldRiuri gamorecxvebiT antiseptikebiTa da antibiotikebiT.

bronqoplevraluri xvrelmilebi

ZiriTadi jgufi sakontr. jgufi

miRebuli efeqti raodenoba % raodenoba %

xvrelmilis daxurva uoperaciod 48 92,3 33 56,9

darCenili Rru da xvrelmili 4 7,7 25 43,1

sul 52 100,0 58 100,0

fistulebis daxurvis sixSire uoperaciod hospitalur periodSi

bronqoplevraluri xvrelmilebi

miRebuli efeqti raodenoba

% raodenoba %

xvrelmilis daxurva, narCeni Rrus likvidacia

14 93,3 10 62,5

darCenili Rru xvrelmiliT 1 6,7 5 31,3

avadmyofis sikvdili - 0 1 6,2

sul 15 100,0 16 100,0

ZiriTadi jgufi sakontr. jgufi

Soreuli Sedegebi 1-dan 3w-mde

rezistentuli tuberkulozi

gaanalizda filtvis tub-ziT daavadebuli 108 pacientis mkurnalobis Sedegebi.

asaki iyo 16-dan 67w-mde; yvela pacienti iyo baqteriagamomyofi; yvela pacientSi iyo gamovlenili rezistentuli (85(78,7%)-Si polirezistentuli) forma;

ZiriTadi jgufis 63(58,3%) pacientis kompleqsur mkurnalobaSi gamoyenebuli iyo sarqvlovani bronqoblokacia;

sakontrolo jgufis 45(41,7%) pacientSi gamoyenebuli iyo xelovnuri pnevmoToraqsi.

rezistentuli tuberkulozi

tuberkulozis formebi raodenoba % raodenoba %

filtvebis fibrozul-kavernozuli tub-zi

33 52,4 16 35,6

infiltraciuli tub-zi rRvevis fazaSi

30 47,6 28 62,2

tuberkuloma rRvevis fazaSi 0 0 1 2,2

sul 63 100,0 45 100,0

ZiriTadi jgufi sakontr. jgufi

Aav-bis ganawileba tuberkulozis formebis mixedviT

rezistentuli tuberkulozi

kliniko-rentgenologiuri dinamika raoden % raoden %

infiltraciis da rRvevis ubnebis Semcireba

51 81 27 60,0

rRvevis Rrus daxurva 6 9,5 - -

dadebiTi dinamikis gareSe 1 1,6 12 26,7

uaryofiTi dinamika 5 7,9 6 13,3

sul 63 100 45 100,0

ZiriTadi jg. sakontr. jg.

kliniko-rentgenologiuri dinamika 3 Tvis mere

daskvna

sarqvlovani bronqoblokacia aris efeqturi, mciredinvaziuri aramedikamentozuri samkurnalo meTodi filtvis tuberkulozis sxvadasxva formebis dros, maT Soris rezistentuli formebisa da iseTi xSiri garTulebebis dros, rogoricaa filtvebidan sisxldena da bronqoplevraluri xvrelmilebi.

amave dros unda aRiniSnos rom es ar aris alternatiuli meTodi da unda gamoiyenebodes kompleqsur mkurnalobaSi.

pacienti 37 wlisqali. 1997 w-s gakeTebuli aqvsmarjvena zedawilis rezeqciatuberkulozisgamo. wlebisganmavlobaSi aqvsgamwvavebebi, racgamoixatebamaRali cxelebiT, xveliT, didiraodenobiTsisxlnarevi, mZafri sunis mqonenaxvelisgamoyofiT

pioToraqsi fistuliT J86.0

ბრონქოპლევრალური ფისტულისბრონქოსკოპიული დახურვa GCSA42

pioToraqsi fistuliT J86.0bronqis sanaTuris bronqoskopiuli

daxurva GCSA42

bronqoskopiis saxelmZRvanelo

sxva, bronqoskopiuli saxelmZRvaneloebebisgan gansxvavebiT, warmovadgineT endobronqialur suraTTanSesabamisi anatomiuri atlasi, romelic piradad mogvawoda torontos universitetis intervenciuliTorakaluri programis direqtorma, prof. kazuxiro iasafukum. evropul da amerikul publikaciebSi mwiriainformacia zogadad, filtvis tuberkulozze da Sesabamisad tuberkulozis endoskopiur problematikaze, romlis ganxilvaSic gamoviyeneT Cveni piradi gamocdileba da agreTve Cveni indoeli kolegebis, kerZod nevinkiSoris mier mowodebuli masala. gavamaxvileT yuradReba saqarTvelos realobasTan Sesabamis iseTpraqtikul sakiTxebze, rogoricaa qarTuli bronqoskopiuli terminologia da klasifikacia, bronqoskopiulikabinetis mowyobiloba da saWiro aRWurviloba, ruTinuli diagnostikuri bronqoskopiis teqnika da biofsiurimasalis momzadeba da rac yvelaze mniSvnelovania, saqarTveloSi danergil da warmatebiT mimdinare, uaxlesintervenciul bronqoskopiul manipulaciebze. ilustraciebis umetesoba warmodgenilia sakuTari arqividan.

gmadlobT yuradRebisaTvis