目的 探讨以纤维支气管镜预观察右上叶支气管开口解剖方位，对插右双腔支气管导管（R-DLT）对位的临床意义。 方法 选择插R-DLT成年患者160例，随机分为实验组和对照组，每组80例。实验组病例麻醉诱导后预先行支气管镜检查，主要测量右主支气管长度及右上叶支气管开口在右主支气管横切面的方位(以患者正前方12点钟位置为0度起点,按顺时针增大)。两组按常规方法将R-DLT插入右侧支气管，之后以纤维支气管镜检查调整导管位置。实验组按之前测定的支气管解剖调整导管深度并作适当的旋转，对照组只调整导管深度使蓝色的支气管套囊上缘在隆突之下见到。然后纤维支气管镜改从右管腔插入通过导管的侧孔查看右上叶支气管开口的对位情况，没有进一步调整就能够看到右上叶支气管开口即为初步对位成功。最后适当微调导管，直至能看清右上肺尖段、后段及前段3个开口。比较两组初步对位成功率以及插管失败率。 结果 实验组右主支气管长度(2.29±0.58)cm，其中短于1cm的有2例，占2.5%；右上叶支气管开口在右主支气管横切面方位(94.5±8.3)°，其中有4例（5.0%）明显偏前或偏后。实验组右上叶支气管开口初步对位成功实验组有77例（96.3%），而对照组为62例（77.5%），组间差异显著（P<0.05）。两组各有1例插管失败，占1.25%，均为右上叶支气管开口与隆突距离较近（<1cm）。 结论 预先以纤维支气管镜查看右支气管解剖有助于提高插R-DLT初步对位的准确性，并利于插管前发现右上叶支气管开口变异而选择合适的导管具有重要意义。

Objective To investigate the clinical value of examining the anatomical position of right superior bronchus orifice preintubation by bronchoscopy on adjusting the position of right double-lumen endobronchial tube (R-DLT). Methods One hundred and sixty adult patients who were scheduled to intubate with R-DLT undergoing thoracic surgery were randomly assigned into two groups (n=80 per group): experimental group and control group. All patients were received intravenous anesthetics for induction. The length of right main bronchus and the position of right superior bronchus orifice in the transverse section of right main bronchus were measured prior to intubation by bronchoscopy in experimental group. The R-DLT was inserted into right bronchus by the conventional method and then adjusted the position by bronchoscopy in two groups. Bronchoscopy was performed through the tracheal lumen to ensure that the endobronchial portion of the DLT was in the right bronchus. The blue endobronchial cuff was just seen below the carina. In addition, lifted or inserted and twisted the tube properly according to the data measured in the experimental group. The relative position of orifices of the tube and the right upper lobe bronchus was assessed by bronchoscopy in the two groups. The R-DLTwas considered as effective preliminary location if right superior bronchus orifice was partly seen through the lateral orifice of R-DLT. The position of R-DLT was further adjusted till the three orifices of segmental bronchi were seen. Results In experimental group, the length of right main bronchus was (2.29±0.58)cm which was shorter than 1cm in 2 cases (2.5%). The central angle in the transverse section of right main bronchus between the central point of right superior bronchus orifice to 12 o’clock position was (94.5±8.3)° which was smaller than 75°or bigger than 105° in 4 cases (5.0%) in total. The number of effective preliminary location of R-DLT was 77(96.3%) in experimental group, and 62(77.5%) in control group, which showed significant difference between the two groups(P<0.05). There was 1 case (1.25%) failed intubation in each group, because of short distance within 1cm between right superior bronchus orifice and tracheal carina. Conclusion Examining the anatomical position of right superior bronchus orifice preintubation is helpful to improve effective preliminary location of R-DLT, and it is beneficial to find out anatomical variation and select appropriate airway tube.