Pulmonary, Critical Care and Sleep Medicine, St Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA, USA.
J Thorac Imaging. 2011 Nov;26(4):263-77. doi: 10.1097/RTI.0b013e318221ec03.
Interventional bronchoscopy, together with other domains of interventional pulmonology, has experienced tremendous technological advances. Diagnostic applications include endobronchial ultrasound, which enables endoscopists to see through airway walls. White light videobronchoscopy, autofluorescence imaging, and narrow band imaging have enhanced the ability to detect early lung cancer at a preinvasive stage. Electromagnetic navigational bronchoscopy, ultrathin bronchoscopy, and virtual bronchoscopy increase the diagnostic yield of biopsy of small peripheral lung lesions. The options that are currently available for the relief of central airway obstruction are also numerous, with both flexible and rigid bronchoscopic applications. Stents, although dichotomized to silicone and metal, come in various sizes and shapes to suit the requirements of the pathology being treated. Ablative techniques are categorized into those with an immediate effect and those with a delayed effect. Laser, electrocautery, and argon plasma coagulation can immediately relieve obstruction and control hemoptysis, whereas cryosurgery, brachytherapy, and photodynamic therapy have established roles in subacute airway obstruction and in the treatment of early lung cancer. Microdebriders have recently been added to the armamentarium of modalities for mechanical debulking of tumor. Distal airway obstruction has also been targeted with bronchial thermoplasty treatment of refractory asthma and with bronchoscopic lung volume reduction for the management of severe emphysema. This array of new technology has fostered collaborative work with a wide range of other medical specialties to deliver safer, more effective, minimally invasive treatment.
介入性支气管镜检查与介入性肺病学的其他领域一样，经历了巨大的技术进步。诊断应用包括支气管内超声检查，使内镜医生能够穿透气道壁进行观察。白光视频支气管镜检查、自体荧光成像和窄带成像增强了在早期非侵袭性阶段检测早期肺癌的能力。电磁导航支气管镜检查、超薄支气管镜检查和虚拟支气管镜检查提高了对小周边肺病变活检的诊断产量。目前，用于缓解中央气道阻塞的选择也很多，包括柔性和刚性支气管镜应用。支架虽然分为硅酮和金属两种，但有各种尺寸和形状，以适应所治疗病变的要求。消融技术分为即刻效果和延迟效果。激光、电烙术和氩等离子体凝固术可以立即缓解阻塞和控制咯血，而冷冻手术、近距离放射治疗和光动力疗法在亚急性气道阻塞和早期肺癌治疗中具有明确的作用。微型切除术最近已被添加到肿瘤机械切除术的工具中。远端气道阻塞也已成为难治性哮喘支气管热成形术治疗和严重肺气肿支气管镜肺减容术治疗的目标。这一系列新技术促进了与广泛的其他医学专业的合作，以提供更安全、更有效、微创的治疗。
