What Is Fiberoptic Endoscopy?

Endoscope is a commonly used medical device. It consists of a flexible part, a light source and a group of lenses. Enter the body through the natural orifice of the human body, or through a small incision made by surgery. When used, the endoscope is introduced into a pre-examined organ to directly observe the changes in the relevant part. The quality of the image directly affects the use effect of the endoscope, and also marks the development level of the endoscope technology. The earliest endoscopes were used for rectal examinations. The doctor inserts a hard tube into the patient's anus and uses the light of a candle to observe the rectal lesions. The diagnostic data that can be obtained by this method are limited. The patient is not only painful, but also the danger of perforation is very high because the instrument is very hard. Because of these shortcomings, endoscopic examinations have continued to be applied and developed, and many different applications and different types of devices have been gradually designed.

Medical endoscope

An endoscope enters the human body through a natural orifice of the human body or a small incision made through surgery. An endoscope is a commonly used medical device. It consists of a bendable part, a light source and a group of lenses. When used, the endoscope is introduced into a pre-examined organ to directly observe the changes in the relevant part. The quality of the image directly affects the use effect of the endoscope, and also marks the development level of the endoscope technology.

The world's first endoscope was created by the French doctor De Somio in 1853. An endoscope is a commonly used medical device. It is composed of a head end, a bent portion, an insertion portion, an operation portion, and a light guide portion. When using, firstly connect the light guide of the endoscope to the matching cold light source, and then introduce the insertion part into the pre-examined organ, and the control operation part can directly observe the lesions in the relevant part.

The earliest endoscopes were used for rectal examinations. The doctor inserts a hard tube into the patient's anus and uses the light of a candle to observe the rectal lesions. The diagnostic data that can be obtained by this method are limited. The patient is not only painful, but also the danger of perforation is very high because the instrument is very hard. Because of these shortcomings, endoscopic examinations have continued to be applied and developed, and many different applications and different types of devices have been gradually designed.

In 1855, the Spanish Cagesa invented a laryngoscope. German Hyman von Heimoz invented the fundus mirror in 1861.

In 1878, Edison invented the light bulb, especially after the emergence of miniature light bulbs, which led to the great development of endoscopes. Surgical endoscopes arranged temporarily could also reach a very precise level.

In 1878, German urologist M. Niz created a cystoscope, which can be used to examine certain lesions in the bladder.

In 1897, the German brother Kilian envisioned a bronchoscope.

In 1862, the German Smoler created an esophagus.

American Kelly created a rectoscope in 1903, but it was not widely used until 1930.

In 1913, the Swedish Jacobs reformed pleuroscopy.

In 1922, American Hindler created the gastroscopy.

In 1928, the German Kalk founded the laparoscopy.

In 1936, the American Skarf performed a ventricular microscopy test, and it was not until 1962 that the Germans Gou and Ferstier founded the ventricular microscopy method. Since then, a series of microscopy methods have been formed.

In 1963, Japan began to produce fiber endoscopes.

In 1964, a biopsy device for fiber endoscope was successfully developed. This special biopsy forceps for biopsy can have suitable pathological materials and is less dangerous.

In 1965, fiber colonoscopy was made, which expanded the scope of examination for lower gastrointestinal diseases.

In 1967, research on magnifying fiber endoscopy was started to observe fine lesions. Fiber optic endoscopes can also be used for in vivo tests, such as measuring body temperature, pressure, displacement, spectral absorption, and other data.

In 1973, laser technology was applied to the treatment of endoscopes, and it has gradually become one of the methods of endoscopic treatment of gastrointestinal bleeding.

In 1981, the endoscopic ultrasound technology was successfully developed. This new development combining advanced ultrasound technology with endoscopes has greatly increased the accuracy of diagnosis of lesions.

Classification according to its development and imaging structure: It can be roughly divided into 3 categories: rigid tube endoscopes, optical fiber (tubular) endoscopes and electronic endoscopes.

Classified by function:

1. Endoscopes for the digestive tract: rigid tube esophagus; fiber esophagus; electronic esophagus; ultrasonic electronic esophagus, fiber gastroscope, electronic gastroscope, ultrasonic electronic gastroscope, fiber duodenoscope, electronic duodenum Colonoscopy, fiber enteroscopy, electronic enteroscopy, fiber colonoscopy, electronic colonoscopy, fiber sigmoidoscopy, and rectoscopy.

2. Endoscopes for respiratory system: rigid tube laryngoscope, fiber laryngoscope, electronic laryngoscope, fiber bronchoscope, electronic bronchoscope, thoracoscopy and mediastinoscopy.

3. Endoscope for peritoneal cavity: there are rigid tube type, optical fiber type and electronic surgical type laparoscope.

4. Endoscopy for the biliary tract: rigid tube cholangioscope, fiber cholangioscope, electronic cholangioscope, and son-in-child cholangioscope.

5. Endoscopy for urinary system: Cystoscopy: It can be divided into cystoscopy for examination, cystoscope for ureteral intubation, cystoscope for surgery, cystoscope for teaching, cystoscope for photography, pediatric cystoscope and women Cystoscope. ureteroscope. nephroscope.

6. Endoscopy for gynecology: colposcopy and hysteroscopy.

7. Endoscopy for blood vessels: vascular endoscopy.

8. Endoscope for joints: arthroscopy.

Reduce the time of endoscopy and take snapshots quickly.

With video and storage functions, it can store images of lesions for easy viewing and continuous control observation;

(3) The color is realistic, the resolution is high, and the image is clear. The image is specially processed to enlarge the image for easy observation.

Using screen display images to achieve simultaneous viewing by one person and multiple people, which is convenient for consultation, diagnosis and teaching of diseases;

Clinical application of medical electronic endoscope

In terms of medical treatment, medical endoscopes are mainly used in surgery and routine medical examinations. Compared with traditional surgery, the functional minimally invasive surgical techniques of medical endoscopes have been widely accepted by doctors and patients. Endoscopes use natural holes in the human body or open a few small holes when necessary. As long as the doctor is skilled in inserting the endoscope lens into the body, other surgical instruments and camera display systems can be used to perform closed surgery in vivo.

The advantages of medical electronic endoscope in clinical application:

The operation is flexible, simple, convenient and more direct;

The patient's discomfort is reduced to a minimum, and the new technology reduces the complexity of the operation and reduces the treatment time.

Greatly improved the diagnosis ability and work efficiency

Facilitate teaching and clinical case discussion, as well as remote consultation,

Facilitate close cooperation between patients and better communication between medical staff and patients

Provide reliable materials for teaching and research

Medical endoscope is an intrusive inspection tool. Its safety factor must be guaranteed. General product performance parameters are: image sensor, image sharpness, lamp light source, auto-focusing range of focus, photography angle of view, weight, power input, Cable length, camera system, power supply, etc.

Working length:

Endoscope products for different purposes have different working lengths. In general:

Laryngoscope working length 180mm;

Sinusoscope working length 175mm;

The outer diameter of the mirror cover is related to the cooperation with the CCD camera system, and the internationally used size is 32mm in diameter.

Mirror tube outer diameter:

Endoscope products for different uses (adults and children) have different outer diameters. In general:

outer diameter of laryngoscope: 5mm, 8mm, 10mm;

Sinusoscope outer diameter 3mm, 4mm;

Optical performance:

Field of view angle: the field of view of the sinusoscope, cystoscope, hysteroscope, rectum, and amniotic fluid should not be less than 60 °, otherwise it will affect the observation range.

Viewing angle: Viewing angle is generally divided into forward view (00 °, 12 °), strabismus (30 °, 45 °), and side view (70 °, 90 °).

Resolution: Resolution is an important optical index of endoscopes. Ordinary endoscopes should generally be greater than 9.92Lp / mm (L = 10mm).

Illuminance: It is mainly the uniformity of illuminance. If the illuminance cannot fill the field of view, the surrounding area will be blurred, which will affect the field of vision.

Mechanical properties:

Sealability: The sealability of the endoscope is related to the imaging quality. If the seal is not good, it will easily leak water, damage the optical system, and affect observation. The joint of the valve sheath of the water valve and the cone of the cystoscope should be tight, and no more than 5 drops of water should be leaked within 1 minute, otherwise the water will leak and affect the operation if the fit is not good.

Surface roughness

Tightness of joints

Insulation performance:

It is mainly the electronic endoscope, the insulation structure of the relevant electrical isolation parts, such as the insulation performance of the eyepiece cover, cold light source interface, light guide cable and other related accessories that are matched with the CCD camera.

Adiabatic performance:

In medical endoscopes, because the endoscope is an invasive inspection tool, in order to avoid injury to the human body when the endoscope is working, cold light sources are now generally used, and infrared filters are set at the light output port to maximize Limit infrared light output.

Medical endoscope maintenance

Endoscopy medical detectors and endoscope imaging workstations have a large investment in equipment, complex systems, high technological content, and high working environment requirements. They have strict requirements for their installation, operation, and use; ensuring that the instruments are always in good working condition. Bringing its effectiveness into full play is of great significance for improving the quality of medical services and achieving the expected benefits: It is especially important to actively do equipment maintenance. According to the new concept of maintenance combined with prevention and prevention, maintenance should include two parts: maintenance and troubleshooting.

. Like other medical equipment, in order to ensure the accuracy of medical endoscope equipment, daily maintenance is very important. Maintenance is active maintenance, also known as advanced maintenance and preventive maintenance.

The use of endoscopes and daily maintenance are generally completed by the use department and the operator. It is a daily work and should be institutionalized. Its content should be written into the operating procedures and precautions: 1 person should be assigned to the use department Technologists who have a certain degree of instrument knowledge and a strong sense of responsibility serve as full-time or part-time instrument managers to assist and guide operators in doing this work. The contents of routine maintenance work generally include:

Clean the computer room and equipment; observe and adjust the temperature and humidity of the computer room to be stable.

Check the machinery, rotation, air, water, screws, nuts and other parts of the machine are normal.

(3) Check whether the switches, knobs, indicators, meters and display parameters on the surface of the instrument are normal.

Before formal work, use the instrument self-test procedure to check the status of each part of the instrument.

Pay attention to whether the instrument has abnormal smell and sound during operation, and whether the image quality is normal.

Check whether the operator operates the instrument in accordance with the regulations and correct it in time.

Because medical endoscopes are an intrusive detection tool, those who use medical endoscopes have undergone rigorous training and assessment.

Endoscope troubleshooting is also called passive maintenance (endoscope maintenance is active maintenance, also known as advanced maintenance, preventive maintenance): medical endoscope imaging system workstation is also the same as various other instruments, in the long-term use process For various reasons, failures are inevitable. Fault repair is still an important task for equipment management and engineering technicians.

Cleaning and disinfection of medical endoscope

Before using medical optical endoscopes, you must carefully read the relevant manuals. While understanding the design, manufacturing process, performance, and other aspects of the endoscope, you must also pay attention to the relevant operating instructions and warning text. In addition to proper use, attention should also be paid to disinfection, cleaning, storage and maintenance ^[1-2] . In the following, the related issues of cleaning, disinfection, and maintenance of medical optical / optical fiber endoscopes are mainly discussed from the environmental requirements of the endoscope, the operation before and after surgery, and the cleaning and disinfection after surgery.

Soak the dried endoscope in the multi-enzyme washing solution for the time according to the instructions.

Immediately after use, rinse thoroughly with running water and wipe dry.

Brush the shaft, bend, and lumen of the instrument thoroughly with a soft bristle brush. Be careful not to scratch the mirror surface when brushing.

Thoroughly clean the components of the endoscope. The lumen should be thoroughly washed with a high-pressure water gun. The removable parts must be disassembled and cleaned, and cleaned with an ultrasonic cleaner for 5-10 minutes.

The method of disinfection and sterilization of fiber optic endoscope: sterilize with WAYWIN2000 medical sterilizer for 30 minutes; or use ethylene oxide for disinfection and sterilization. In recent years, more medical institutions have selected low-temperature formaldehyde steam sterilizers, which are characterized by reliable sterilization and no passivation effect on the lens.

Low temperature formaldehyde steam sterilizer

Endoscopes or endoscope components suitable for pressure steam sterilization should be pressure steam sterilized. Pay attention to selecting the temperature and time according to the requirements of the endoscope instructions.

Endoscopes and accessories that cannot be pressure steam sterilized can be sterilized by soaking in 2% alkaline glutaraldehyde for 10 hours.

When disinfecting and sterilizing with disinfectant, instruments with shaft joints should be fully opened, and instruments with lumen should be fully filled with disinfectant.

Medical endoscope cleaning and maintenance

The operation of medical endoscopes should be gentle. Rotate the curved angle handle slowly and use even force. Do not use force or excessive force. When the bent part is fixed, do not turn the bent handle, otherwise the traction wire will be broken. When holding the camera, hold the joints of the camera and the handle tightly, avoid holding the wire harness and hanging the joint, otherwise the glass fiber bundle will be damaged.

During the surgical procedure, the blood stains should be wiped off with sterile water immediately after the use of the fiber optic endoscope instrument, and the instrument should not be disassembled and immersed to avoid loss or left in the body.

Postoperative endoscope cleaning and maintenance

Equipped with corresponding cleaning equipment and articles, instrument cleaning fluid, lysozyme, rust removing fluid and lubricant. Cleaning equipment includes: running water cleaning and disinfection tank (three tanks: cleaning tank, enzyme cleaning tank, rust removal tank) high-pressure water gun, drying equipment, timer, ventilation facilities, various brushes, gauze, cotton swabs.

Residual scouring and washing: remove the removable part immediately after the endoscope and instruments are operated, and wash the washing tank thoroughly with running water to remove residual materials such as blood and mucus and wipe them dry; Quka and various surgical forceps and scissors Devices and joints are removed with a soft-bristled brush, and high-pressure water jets are used to flush various lumens, catheters, and lumens.

Disinfection and enzymatic washing: Put the wiped endoscope and instruments in a 1: 270 full-effect enzyme washing solution bath, soak it for 30 minutes or use an ultrasonic cleaner to shake and clean for 5 to 10 minutes.

Rinse: Endoscopes and instruments that have been soaked in the full-effect enzyme wash solution are thoroughly washed with flowing water in the rinse tank. Lumen instruments are rinsed with a high-pressure water jet during the cleaning process to remove the full-effect enzyme wash solution and Loose dirt. When cleaning the disassembled part of the instrument, not only the outer surface of the instrument, the shaft joints, bends of the instrument, and the lumen are thoroughly washed with a soft brush. Avoid scratching the mirror surface when brushing the endoscope.

Antirust and derusting: After the above treatment, the instrument is immersed in a 1: 7 derusting solution. The immersion time is 10 minutes. After soaking, rinse with water.

Lubrication maintenance: Put the instruments in the 1:15 lubricating solution and soak them. After soaking for 2 to 3 minutes, pick them up to dry or dry.

When using the endoscope, professional personnel should be used as much as possible for operation, and relevant personnel can be trained under appropriate conditions. Fiber optic endoscopes are precision and valuable equipment and instruments. They should be managed by special personnel. Before use, strictly follow the manufacturer's instructions for pre-job training. Familiar with its performance, characteristics, principles, operating procedures, use and maintenance methods to reduce damage to the instrument. .

Medical endoscope troubleshooting

In terms of organizational management: such as the division of professional groups, one specialist and multiple abilities; the calculation of the complex coefficient of the instrument, and reasonable sharing; the division of the department or the instrument to the person, responsible for the responsibility; the organization of the fault consultation; the chief engineer responsibility system, etc.

In terms of personnel training: such as the combination of introduction and cultivation, gradually forming a talent echelon, the combination of on-the-job improvement and delivery training, the deepening of basic theories and the improvement of professional technology.

In terms of maintenance procedures: first understand the cause of the failure of the instrument, be familiar with the working principle of the instrument, and then use the basic theoretical knowledge you have mastered to analyze the possible parts of the failure against the circuit diagram of the instrument, gradually detect and troubleshoot, find out the real part of the failure, and finally repair Or replace the faulty part, and complete local or complete machine debugging.

Maintenance method: should follow the inquiry first, then diagnose; first visual, then test; first comprehensive, then local: first drive, then circuit; first independent, then the whole machine; first peripheral, then chip; first control, then data; first Principles of dialectical relations such as qualitative and post-quantitative.

There are more mechanical parts than circuit parts in the fault parts. There are more high-voltage parts than weak-current parts. More high-temperature parts than low-temperature parts. There are more power parts than main parts. There are more drive parts than stationary parts. There are more objective devices than semiconductor devices, more analog circuits than digital circuits, and detection methods include percussion, visual, measurement, comparison, replacement, temperature change, signal tracking, signal input, and front-back tracking. , Load separation and other practical methods.

Regular maintenance of medical endoscope

The regular maintenance of medical endoscope equipment is usually completed by the instrument manager and engineering technicians. It is an organized and planned maintenance measure that is performed continuously and cyclically. This is conducive to grasping the operating rules of the instrument and is beneficial to the failure of Search: The content and time of regular maintenance, different instruments have different practices. Generally can be divided into 3 levels:

Yiyibao: Generally, it can be carried out once a month to a quarter. In addition to the daily maintenance work of the factory, the main contents can be disassembled to remove the casing, remove dust, dirt, foreign objects, tighten screws, and add lubricants; inspection services Whether the components and components are worn, deformed, ablated, punctured, loosened, wet, aging, poorly grounded, etc .; check the voltage and ripple of each group of power, check the operation and contact of high-voltage components, etc .;

Erbao: Generally, it can be performed once every six months to one year. In addition to ensuring a guarantee, the sensitivity and accuracy of each instrument and operation control system on the console of the whole machine can be tested and corrected, and the measurement verified. Replace the expiring loss products such as the insulation of the high-voltage generator. The voltage and waveform of each test point are tested systematically and the bias test is performed;

(3) Three guarantees: Generally, it can be carried out once every 2-4 years. In addition to the second guarantee, the entire contents can be disassembled for cleaning and maintenance if necessary. Components that exceed the service life should be replaced or repaired as much as possible. It is quite possible to carry out a comprehensive and thorough debugging and restore its working accuracy and performance to the extent that it reaches or exceeds the new machine.

Maintenance of medical endoscope equipment

In all departments of the hospital, the use of medical endoscopes is extremely strict. The requirements of the endoscope on the use environment: the indoor environment is mainly a dark room environment, to avoid direct light, the operation began to turn off the fluorescent lamp, lighting with a shadowless lamp, indoor before surgery The temperature is maintained at 22 ~ 25 , humidity is about 50%, acid proof, alkali proof and steam proof. Avoid interference from strong electricity and electromagnetic fields. The voltage is stable during the operation, and the continuous voltage regulator maintains the voltage of 220 V to avoid damaging the precision instruments.

Indoor instrument positioning: The power socket in the operating room should be suspended from the roof, to avoid interference with the power cord caused by staff walking and touching the power socket, to ensure the smooth operation, and to avoid instrument damage due to unstable voltage.

Monitor: Generally, the relevant monitors have been tested and adjusted to the best display state by the relevant technicians during the installation. Therefore, it is not recommended for users to debug by themselves. If the monitor does not display, check the connection between the power strip and the power cord, whether the display switch is on, whether the camera system is on, and whether the output of the camera system is properly connected to the input port of the monitor. After the color is distorted, the optical interface of the camera system can be aimed at the object or picture with bright colors, and the contrast, saturation, and brightness can be adjusted through the menu on the monitor. Avoid strong magnetic objects near the monitor, and perform demagnetization maintenance regularly. When the magnetization is serious or the demagnetization fails, please contact the manufacturer's technical staff.

Camera system and light source: Although many medical endoscopes declare that the optical interface is waterproof, the optical interface and the connecting cable are not recommended to be sterilized. It can be put on a germproof cover, and the germproof cover is sterilized each time. Service life, if you must disinfect, please use low temperature fumigation. The socket should not be forced to be pulled out. Align it with the twelve o'clock position, pull straight and gently, and perform regular white balance calibration. Prevent the optical interface from contacting the liquid, even if it is a waterproof device, so do not immerse the focusing head and the cable. If you are not in contact with liquid such as glucose, please wipe the surface of the optical interface with a dry cloth immediately after the operation. Prevent the instability of the crystallization movement of the bayonet. If there is an abnormality, please do not force it. Optical cables cannot be sterilized by soaking or high-temperature and high-pressure methods. If disinfection is required, wipe the surface with low-temperature fumigation or light alcohol to disinfect. The user should carefully record the use time of the light source bulb, and prepare a spare bulb when the service life is approaching. Light source bulbs have a limited life span. It is recommended to turn off the light source immediately when not in use.