系统性支气管镜检查：四个标志方法
Summary
在这里，我们提出了一种以结构化方式导航支气管迷宫的协议，将支气管镜检查分成逐步方法——四个标志方法。
Abstract
纤维支气管镜检查是一项技术上困难的手术，已被确定为最重要的手术，应整合到肺科医生基于模拟的培训计划中。然而，需要更具体的支气管镜检查培训指南来满足这一需求。为了确保患者能够胜任检查，我们提出了一种系统的、循序渐进的方法，将程序分为四个“里程碑”，以支持新手内窥镜医师在支气管迷宫中导航。该程序可以根据三个既定的结果指标进行评估，以确保对支气管树进行彻底有效的检查：诊断完整性、结构化进展和手术时间。
丹麦的所有模拟中心都采用了依赖于四个地标的逐步方法，并正在荷兰实施。为了在培训时为新手支气管镜医师提供即时反馈，并减轻顾问的时间限制，我们建议未来的研究在培训新的支气管镜医师时应将人工智能作为反馈和认证工具。
Introduction
肺癌是癌症死亡的主要原因1.可弯曲支气管镜检查对于在支气管树中导航并确定肺癌诊断和分期的正确节段以及为患者分配正确治疗至关重要2.在受训者学习曲线的早期部分，诊断活检材料的产量较低，并发症发生率较高，患者不适感增加 3,4,5。为确保对患者进行独立/无监督的实践，必须达到令人满意的教育水平。确保基本能力的一种培训方式是基于模拟的掌握学习，即受训者练习直到达到熟练程度标准6.已经开发了几种工具来评估支气管镜检查的性能7,8，并且已经建立了以下性能指标：（1） 诊断完整性 （DC） – 可视化节段的比例9;（2） 结构化进度 （SP） – 按正确进度顺序访问的路段数10;（3） 手术时间 （PT） – 从通过声带到手术结束的时间9.
新手支气管镜医师可能会被迷宫弄糊涂，看起来像相似的支气管，并且有些人未能完成基于模拟的支气管镜检查课程11，尽管它已被确定为肺病学中最重要的技术程序12。因此，通过该协议，我们提出了通过支气管树的逐步结构化进展（图1），依靠四个标志作为指导。我们建议新手操作者应根据这种方法进行教学，以确保在最短的时间内以结构化的方式可视化所有支气管节段，并正确处理内窥镜。
Protocol
根据丹麦法律，没有患者参与的教育研究不需要伦理批准。 1. 范围的处理 左手握住支气管镜，左手拇指放在转向杆上，左手食指放在抽吸按钮上。用右手握住支气管镜的远端。 用直臂和手腕握住示波器，使吸力按钮直接指向前方，转向杆处于中立位置，定义为中立位置或 0°。通过扭动手腕，将示波器从中立位置/0° 转动。 上下移动拇指以…
Representative Results
自 2011 年以来，CAMES 一直在教授四个里程碑方法，其中基于模拟的支气管镜课程通过最终测试结束 13.从 2015 年到 2017 年，有 77 名参与者参加了该课程，其中只有 33 人 （43%） 完成了11 门课程。完成率低是由于几个因素造成的：时间限制、课程不是强制性的、产假以及没有受保护的培训时间。在完成课程的人中，14人（42%）认为完成课程的最重要因素是：“基于…
Discussion
我们建议对支气管节段进行系统而完整的检查，将支气管镜检查分为四个标志，以帮助指导新手支气管镜医师通过支气管迷宫。由于需要更具体的支气管镜检查培训指南14，我们建议应使用三种基本结局指标来评估我们的系统和阶梯式方法：DC、SP 和 PT。
DC 和 PT 是既定的结果测量方法，也是评估支气管镜检查性能时首次使用的指标9。支气?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
作者没有致谢。
Materials
| Evis Exera II | Olympus | Not provided | Endoscopy Tower |
| BF-Q180 Bronchoscope | Olympus | Not provided | Flexible Bronchoscope |
| CLA Broncho Boy | CLA | Not provided | Bronchial Tree Phantom |
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Citazione di questo articolo
Cold, K. M., Vamadevan, A., Nielsen, A. O., Konge, L., Clementsen, P. F. Systematic Bronchoscopy: the Four Landmarks Approach. J. Vis. Exp. (196), e65358, doi:10.3791/65358 (2023).