Nita Corry Agustine Nias

RSUP dr. Ben Mboi Kupang

Peran Bronkoskopi pada Penyakit Paru

• Bronkoskopi merupakan prosedur medik untuk melihat saluran napas
(melihat/mencari abnormalitas).

• Alat yang digunakan : bronchoscope.

• Dibagi : rigid bronchoscope dan flexible bronchoscope.

• Diagnostic bronchoscopy dan therapeutic bronchoscopy.

Interventional Bronchoscopy. Bolliger CT, Mathur PN.

 Rigid bronchoscope Flexible bronchoscope

Didemostasikan oleh Gustav Killian Diperkenalkan oleh Shigeto Ikeda tahun

(University of Freiburg) tahun 1966 di Copenhagen, Denmark.
1897.

Interventional Bronchoscopy. Bolliger CT, Mathur PN.

 Rigid bronchoscope Flexible bronchoscope

• Terapetik. • Diagnostik dan terapetik.

• Trakeal (33 cm) dan bronkial (43 cm). • Panjang 500 – 600 mm.
• Outer diameter 6 – 14 mm. • Chanel size : 1 , 2 mm ( ultrathin) – 3 , 2
mm (therapeutic).
• Outer diameter 2,2 – 6,9 mm.

Shanghai Chest, 2020. Thoracickey.com / Olympus

Tim bronkoskopi Bronkoskopi unit Operating room Pasien

Indikasi?

Informed consent

Kondisi meningkatkan
risiko tindakan?

Ward, ICU, ER

KONTRAINDIKASI
Forcep, jarum, sikat, dll (absent of consent, inexperienced operator, inadequate facilities and
personnel, inabilities to adequately oxygenate, coagulopathy)
Interventional Bronchoscopy. Bolliger CT, Mathur PN.
 Diagnostic bronchoscopy Therapeutic bronchoscopy

• To evaluate lung lesions of unknown etiology.

• To remove retain secretion or mucus plugs not
• To assess airway patency. mobilized by conventional
• To investigate unexplained hemoptysis, unexplained noninvasive technique.
cough, localized wheeze or stridor.
• To investigate the etiology of unexplained paralysis of
vocal cord, unexplained pleural effusion, xylothorax. • To remove foreign bodies.
• To stage lung cancer.
• To obtain material for microbiologic study (pulmonary
infection).
• To remove abnormal endobronchial tissue of
foreign material by use of forceps or
• To evaluate the airways for suspected bronchial tear or
other injury.
laser techniques.
• To evaluate suspected tracheoesophageal fistula.
• To determine the location and extent of respiratory tract • To perform difficult intubations (cervical
injury after acute inhalation. spondylitis, dental problems,
• To obtain material for study from lungs of patients with myasthenia gravis, trauma of head,
diffuse or focal lung disease. neck, larynx or trachea).
Interventional Bronchoscopy. Bolliger CT, Mathur PN.
Kanker paru
• Kanker primer yaitu tumor ganas berasal dari epitel bronkus atau
karsinoma bronkus.
• Dasar diagnosis : klinis (gejala, faktor risiko), radiologik, tindakan
khusus (bronkoskopi).
• Tujuan tindakan bronkoskopi : evaluasi saluran napas, pengambilan
sampel, staging.

Kanker Paru. PDPI

Bronkoskopi + EBUS + TBNA

EBUS = endobronchial ultrasound, TBNA = transbronchial needle

aspiration

EBUS = linear probe dan radial probe

Linear probe

Radial probe

Lung India, 2009.

https://mforum.com.au/endobronchial-ultrasound/
Peripheral Lung Lesions
• Bronchoscopy + EBUS-GS (guided sheets) + fluoroscopy.
• A systematic review and meta-analysis dari Jian Ye et al (Thoracic
Medicine, 2017)  EBUS-GS + fluoroscopy lebih baik
dibanding trans-bronchial biopsy (TTB).

Annals of Thoracic Medicine 2017 / BMC Pulmonary Medicine 2018.

Tumor intrabronkial
Laki-laki, 36 tahun. Sesak napas, bunyi mengi ipsilateral (kiri).
Dilakukan bronkoskopi diagnostic dengan flexible bronkoskop.

< -BUKa

rina
Ka

BUKi ->
Pasien dirujuk ke RSUP Persahabatan,
Jakarta (Departemen Pulmonologi dan
Kedokteran Respirasi FKUI).

Dilakukan tindakan pengangkatan tumor

dengan rigid bronkoskop, dilanjutkan
cryotherapy dan aplikasi APC (argon
plasma coagulation).

Dikerjakan oleh dr. Mia Elhidsi, SpP(K)

Courtesy of dr. Mia Elhidsi, SpP(K)

Cryotherapy

• Penghancuran massa tumor melalui

efek sitotoksik pendinginan (-20 dan -
40 derajat Celcius).
• Jaringan cryo-sensitive : kulit,
membrane mukosa, jaringan granulasi.
• Jaringan cryo-resistant : lemak,
kartilago, jaringan ikat.
• Cryogen : Liquid nitrogen (LN2),
nitrous oxide (N2O).
• Efek : kristalisasi tingkat sel.

Interventional Bronchoscopy. Bolliger CT, Mathur PN.

APC (argon plasma coagulation)

• Kontrol perdarahan pada tumor yang

berdarah.
• Terjadi nekrosis koagulasi superfisial
secara homogen.

Interventional Bronchoscopy. Bolliger CT, Mathur PN.

Foreign body removal
(Flexible bronchoscope)

Interventional Bronchoscopy. Bolliger CT, Mathur PN.

Anak perempuan, 13 tahun. Ketika memperbaiki hijab, jarum pentul
digigit dan tertelan, masuk saluran napas.
Bronkoskopi pasien ICU

J Thorac Dis, 2021

Bronkoskopi pada kasus intubasi
sulit

https://rc.rcjournal.com/content/59/6/865
Bronchoscopy in near drowning
• Dilakukan jika terdapat bukti bahwa korban terinhalasi benda asing.
• Pasir, lumpur (banjir), benda asing.
• Risiko : pneumonia.
• Bronkial toilet dengan NaCl 0,9%.

ATS, 1997
Terima kasih