Tracheal stenosis of the trachea

The causes of tracheal stenosis include congenital (such as abnormal development of the trachea) and acquired causes, such as scar stenosis after various inflammations or trauma, and long-term oppression by tumors around the trachea (such as thyroid tumors), which can cause tracheal stenosis. Wall softening and stenosis; stenosis after tracheotomy or intubation; stenosis after radiation therapy for adjacent lesions. With the increasing number of cases of mechanical respiratory therapy and radiation therapy, tracheal stenosis caused by these two reasons has become increasingly common. Tracheal stenosis is an irreversible and progressive disease. The only effective treatment is surgical removal of the lesion. Because the disease course is progressive, there is also the risk of sudden complete tracheal obstruction. Surgery should be performed as soon as possible to achieve good and accurate results.

Treatment principles:

1. Circular excision of the lesion and end-to-end anastomosis is the main treatment method for tracheal stenosis.

⒉For cases in which the tracheal lumen is blocked only by granulation tissue, the granulation tissue can be removed with a bronchoscope or the trachea can be incised and the granulation tissue can be scraped off under direct vision to facilitate smooth ventilation. 3. For stenosis caused by long-term compression of adjacent organ tumors and softening of the tracheal wall, on the basis of relieving the compression, use ribs to fix the softened area to overcome the stenosis.

⒋If the stenotic area is too long and is not suitable for resection and end-to-end anastomosis, a tube can be built into the trachea and led out of the body through the stoma to relieve tracheal obstruction and ensure smooth breathing.

⒌Be careful when performing end-to-end anastomosis for tracheal lesions in infants and children. Because infants or children have a lower tolerance to tension at the opposite end of the tracheal anastomosis than adults, and the diameter of the tracheal lumen is small and the tolerance to edema is poor, the surgery should be postponed as much as possible.

⒍Anti-infective treatment should be paid attention to during the treatment process. Infection can aggravate the degree of tracheal obstruction, increase the difficulty of treatment, and can also cause risks such as complete tracheal obstruction.

Auxiliary examination:

1. If the lesion is limited and the infection is not serious, the examination project will mainly focus on the examination frame "A";

⒉ The lesion range is wide Or if the infection is severe, the inspection project may include inspection boxes "A" and "B".

Effectiveness evaluation:

1. Cure: After the lesion is removed, the symptoms disappear and ventilation becomes unobstructed.

⒉Improvement: Symptoms improved after the lesion was removed or catheterized.

⒊Not healed: Symptoms have not improved.

Diagnosis:

1. Progressive: obstructive dyspnea, wheezing when inhaling, and in severe cases, three concave signs.

⒉Tracheal stenosis was seen on plain chest X-ray and tracheal cross-section.

⒊Bronchoscopic examination revealed stenotic lesions.

Health guidance:

Tracheal stenosis can be treated and prevented. When performing a tracheotomy, avoid incision that is too high to avoid damaging the first cartilage ring; avoid resecting too much of the anterior tracheal wall; pay attention to the appropriate position of the tracheal tube to prevent the tube from compressing the anterior wall of the trachea; avoid passing the tube connected to the outside of the tracheal tube; The tracheal tube should be too heavy and too rigid; avoid over-inflation of the endotracheal tube balloon and excessive pressure, etc., which can effectively prevent tracheal stenosis or reduce its incidence.

Tracheal stenosis is an irreversible disease and tends to get worse. Therefore, except for infants and children, it is advisable to undergo surgery as soon as possible to remove the disease and anastomose the trachea from end to end. Tracheal stenosis is often accompanied by varying degrees of infection. Infection can often aggravate tracheal obstruction, and tracheal obstruction can also aggravate infection, forming a "vicious cycle" that can lead to complete tracheal obstruction in a short period of time and put the patient in a critical state.

Therefore, when treating tracheal stenosis, in addition to seeking surgical resection of the disease with definite curative effect as early as possible, it is also very important to effectively control the infection. Although tracheal lipiodol angiography is valuable in diagnosing tracheal stenosis and understanding the scope of stenosis, it has the risk of aggravating tracheal obstruction and should be noted.

Related examinations:

Bronchography ABronchoscopic AGeneral radiography examinationAAspartate aminotransferase (AST, GOT)AAlanine aminotransferase (ALT, GPT) A Globulin (G) A Albumin (Alb) A Total protein (TP) A Indirect bilirubin (SIB) A Direct bilirubin (SDB) A Total bilirubin (STB) A Stool routine examination A Routine urine examination A Routine blood examination B Sputum culture + drug sensitivity test B Chest CT examination

Principles of medication:

⒈For patients with mild symptoms of localized infection, the medication should be "A" host.

⒉For patients with extensive lesions and severe infection, the drug selection may include medication limits "A", "B" or "C".