Unit of Thoracic Endoscopy, San Camillo Forlanini Hospital, Rome, Italy.
Unit of Respiratory System Diseases, San Giovanni Addolorata Hospital, Rome, Italy.
Panminerva Med. 2019 Sep;61(3):298-325. doi: 10.23736/S0031-0808.19.03602-4.
We describe the current knowledge and skills for the main techniques of operative bronchoscopy and their applications in the treatment of malignant and benign central airway disorders. Rigid bronchoscopy has a history of over 100 years. The use of rigid bronchoscopy was abandoned upon the introduction of the fiberoptic bronchoscope but has made a reappearance with the development of interventional pulmonology in the late nineteenth and early twentieth century. The advantages of rigid bronchoscopy include allowing simultaneous procedures, such as ablation, debulking and suctioning, without limiting ventilation but at the moment there are no standard approaches to perform the procedure. Rigid bronchoscopy also plays a vital role in stent placement, repositioning, maintenance and removal. An interventional pulmonology practice should only be developed when there is a locoregional unmet medical need and when a dedicated interventional pulmonology unit can be guaranteed. These departments should be available 7 days a week and should provide a fast and appropriate response to referrals in emergency cases. There is a clear need to define a competency-based training program for rigid bronchoscopy, including stent placement. An optimal, multimodality training program for bronchoscopy should include didactic lectures, web-based learning, case-based reviews and hands-on training.
我们描述了操作支气管镜检查的主要技术的当前知识和技能及其在治疗恶性和良性中央气道疾病中的应用。硬质支气管镜已有 100 多年的历史。纤维支气管镜的引入使得硬质支气管镜的使用被放弃，但在 19 世纪末和 20 世纪初介入肺病学的发展下，它又重新出现。硬质支气管镜的优点包括允许同时进行消融、减容和抽吸等程序，而不会限制通气，但目前还没有进行该程序的标准方法。硬质支气管镜在支架放置、重新定位、维护和移除方面也起着至关重要的作用。只有在存在局部未满足的医疗需求并且可以保证有专门的介入肺病学单位的情况下，才应开展介入肺病学实践。这些部门应该每周 7 天开放，并应在紧急情况下为转介提供快速和适当的回应。显然需要为硬质支气管镜检查（包括支架放置）定义基于能力的培训计划。支气管镜检查的最佳多模式培训计划应包括理论讲座、基于网络的学习、基于案例的复习和实践培训。
