TRACHEA

From Big Medical Encyclopedia

TRACHEA [trachea (PNA, JNA, BN A); Greek tracheia (arteria) a windpipe] — the cartilaginous hollow tube located below a throat, which is initial department of the lower respiratory tracts.

Embryology

of T. develops from the epithelial laryngotracheal bookmark appearing on a ventral wall of a front gut on 3 — the 4th week of embryonic development, kpereda from laying of a gullet. In development it is extended, its gleam extends, and the caudal end comes to an end with two hollow protrusions which are laying of primary bronchi. Hyaline cartilages of T. are differentiated at the end of the 2nd month from the mesenchyma located about ventral and lateral its walls. Bunches of smooth muscle cells and connective tissue components of a wall of T are formed of the mesenchyma lying about a dorsal wall. Glands T. are put at the end of the 4th month in the form of epithelial tyazhy.

A comparative anatomy — see. Respiratory system.

Anatomy

of T. the adult (fig. 1) begins at the level of bottom edge

of the VI cervical vertebra and reaches

the IV—V chest vertebra, making in length of 11 — 13 cm. Its top end connects to a cricoid of a throat a perstnetrakhealny sheaf (lig. cricotracheale), in the bottom of T. is divided into the right and left primary bronchi; the place of division carries the name of bifurcation of a trachea (bifurcatio tracheae). Diameter of T. depends on age, varies individually, it is not identical on its extent at the same chelove-


of Fig. 1. Diagrammatic representation of a trachea and some bodies, adjacent to it, (anterior aspect): 1 — a thyroid cartilage;

2 — a gullet; z — an aortic arch; 4 — the left primary bronchus; 5 — the right primary bronchus; 6 — bifurcation of a trachea; 7 — cartilages of a trachea; 8 — ring sheaves; 9 — a perstnetrakhealny sheaf; 10 — a cricoid; 11 — a cricothyroid sheaf.

also decreases before the place of division of T. on bronchial tubes. Around a trachea friable connecting fabric is located (see), thanking a cut shifts of T are possible. at the movements.

T. divide into two parts — short cervical (pars cervicalis) and long chest (pars thoracica). A cervical part is covered with skin, superficial and pretracheal plates of a cervical fascia, lobbies (subhypoglossal, T.) muscles of a neck, fatty tissue. On a front surface of the II—IV cartilages of T. there is an isthmus of a thyroid gland (see). The lower ends of shares of a thyroid gland at their average development reach

the V—VI level of cartilages of T. Behind T., acting from under its left edge a little, there passes the gullet, and between them — recurrent guttural nerves (subitem of laryngei recurrentes). The distance between a trachea and a gullet in the field of cervical department is more, than in the field of chest. At the left and to the right of a trachea the left and right neurovascular bunches of a neck are located (see). Chest part T. it is located between pleural bags of the right and left lung (see the Pleura) in an upper mediastinum (see). Above bifurcation of a trachea the aortic arch which is bending around a trachea at the left lies. Ahead the brachiocephalic trunk, the beginning of the left general carotid artery, the left brachiocephalic vein are located, children — in silt have-point gland.

Wall of T. consists of 16 — 20 hyaline cartilages (cartilagines tra-cheales) connected by ring-shaped sheaves (ligg. anularia); cartilages behind do not become isolated, and connect a webby wall (membrane) formed by connecting and smooth muscular tissue. In cervical part T. cartilaginous and webby walls have the greatest thickness. The webby wall (paries membranacea) gradually extends to a lower part of chest part T.

Inner surface of T. it is covered by a mucous membrane (tunica mucosa) covered with a multirow ciliary epithelium (see. Epithelial fabric), the movements of cilia to-rogo are directed krani-alno. In a mucous membrane there is a dense network of elastic fibers. In a submucosa a large amount of the mixed mucous glands, output channels is located to-rykh open on a surface of an epithelium (see. Mucous glands). Mucous membrane of T. has the good soaking-up ability that is important, e.g., at inhalations of pharmaceuticals.

Blood supply of a trachea is carried out from tracheal branches (rr. tracheales) of the lower thyroid artery (. thyroidea inf.), from branches of an internal chest artery (a. thoracica int.) and chest part of an aorta (pars thoracica aortae). A venous blood flows on tracheal veins (vv. tracheales) in the lower thyroid vein (v. thyroidea inf.) and internal chest veins (vv. thoracicae int.).

The lymph drainage is carried out in the next limf, nodes: peritracheal (nodi lymphatici paratracheales), T located lengthways.; upper tracheobronchial (nodi lymphatici tracheobronchiales sup.), the tracheas which are lateralny at the place of its division into primary bronchi; lower tracheobronchial nodes (nodi lymphatici tracheobronchiales inf.), the tracheas lying under bifurcation between primary bronchi. Innervate a trachea of a branch of a vagus nerve (n. vagus), a recurrent guttural nerve (item laryngeus recurrens) and a sympathetic trunk (truncus sympathicus).

Radioanatomy. On roentgenograms in a direct projection of T. has an appearance of the light air column holding average position in an upper part of a thorax; it clearly is traced from above from a cervical part to

the IV—V level of chest vertebrae, i.e. before bifurcation of a trachea. Imposing of a shadow of a backbone, breast, the sternal ends of clavicles on direct roentgenograms does not allow to receive the clear image of T. in the place of transition of its cervical part to chest. At a research T. in side and slanting projections pictures make in vertical position of the patient with the hands crossed over the head. In such situation T. it is visible in the form of the light strip which is narrowed a cone from top to bottom. Front wall of T. at the level of bifurcation will be spaced from a breast on 8 — 10 cm, and at the level of an upper aperture of a thorax — on

1 — 1,5 cm. At the same time the lower and average departments of chest part T are better looked through. Upper part of chest part T. in these projections it is visible badly since it is blocked by shadows of muscles and bones of a shoulder girdle. For receiving more sharp image of T. make a tomography (see); on the tomogram the uniform enlightenment on the centerline of an upper part of a difficult cell (fig. 2) is well visible. Width


of Fig. 2. The tomogram of a trachea is normal (a direct projection): enlightenment with equal contours throughout a trachea.

a gleam of a chest part of a trachea on the tomogram at adults the cm, thickness of walls of 2 — 3 mm makes from 2 do3,5. Stepped appearance of sidewalls of T. on tomograms in a direct projection it is caused by cartilages of T. and ring-shaped sheaves. At persons 40 years stepped appearance of walls of T are more senior. it becomes more noticeable. On tomograms in a side projection a front wall of T. has also small stepped appearance, a back (webby) wall smooth and equal.

Pathological anatomy

At assessment patol. changes of a trachea during opening it must be kept in mind age and postmortem changes, and also possible anomalies of its development. Usual age change of a trachea is the atrophy of her mucous membrane at advanced age owing to what cartilages considerably eminate in a gleam of T. Age calcification of cartilages is expressed usually in small degree and has no such constant character as calcification of cartilages of a throat. The considerable calcification which is combined with ossification of cartilages usually is a consequence hron. inflammatory processes (hron. tracheitises, tuberculosis, syphilis, scleroma, etc.).

To anomalies of development of basic fabrics T. refer the heterotopic formation of islands of a cartilaginous and bone tissue which is observed sometimes in a mucous membrane between cartilaginous rings of a trachea (see Trakheobropkhopapgiya hondroosteoplastichesky). At calcification and ossification of cartilages of T. the configuration of its gleam can change and get instead of cylindrical a form of a so-called saber sheath.

Circulatory disturbances in a trachea develop in combination with disturbances of blood circulation of a throat. The arterial hyperemia of a mucous membrane of a trachea is observed in an initial phase of acute tracheitis. Venous plethora of T. happens manifestation of the general venous stagnation at heart diseases, emphysema of lungs or at difficulties of venous outflow of local character. At the same time the redness with a cyanotic shade of a mucous membrane, well noticeable in the field of interchondral intervals is observed. In a trachea more often than in a throat, there is a varicosity, a cut can give a heavy pneumorrhagia. Hemorrhages in a mucous membrane of T. are observed at acute tracheitis, heavy inf. diseases, sepsis, hemorrhagic diathesis, asphyxia, poisonings, damages of T. Hemorrhages in T. are usually more expressed, than in a throat, quite often her mucous membrane throughout is impregnated with blood (see Imbibition). The hypostasis of a mucous membrane of a trachea taking place during lifetime on a corpse is swept usually poorly up and remains only in back webby department.

Deposits of amyloid (see Amyloids) are observed in a front wall of cervical part T., and also in the field of bifurcation. Amyloid deposits eminate in a gleam of a trachea in the form of pink translucent dense masses. As at an infiltrative, and knotty form of an amyloidosis the phenomena of a tracheostenosis are noted.

Necroses in a trachea (see the Necrosis) can be observed in the form of decubituses at an intubation (see the Intubation, tracheas) and tracheostomies (see) from pressure of a tracheostomy tube. Nek-ry pathological changes of T. can be caused by defeats of the bodies and fabrics surrounding T., napr, perforation of T. at a softening adjacent limf, nodes as a result of an anthracosis or a caseous necrosis at tuberculosis.

Black color of cartilages of a throat and T., caused by adjournment homogentistic to - you, meet at an alkaptonuria (see the Ochronosis).

Methods of a research

Direct survey of a trachea (trakheosko-piya) can be executed at a direct laringoskopiya (see) by means of tubular or zhelobovaty pallets (Bryuningsa, Tikhomirov, Undritsa, etc.), to-rye enter through an oral cavity and a throat (an upper tra-heoskopiya) or through a tracheotomic opening (the lower trakheo-skopiya). In a crust, vrekhlsh widely apply a direct trakheobronkho-skopiya (see Bronkhoskopiya) bronkhofibroskopam with a fiber optics (see Endoscopy, endoscopes), with the help to-rykh it is possible to examine T. and bronchial tubes and in the presence of indications to make necessary endoscopic manipulations.

At rentgenol. a research to receive the image of cervical and chest parts T. on one roentgenogram it is not possible therefore a cervical part is removed separately. For increase in air contrast of T. the picture is made at height of a deep breath. At polipozitsnon-number raying establish degree of mobility, smeshchayemostp and elasticity of walls of T., existence of excess mobility of a webby wall of T. at an expiratory stenosis, a thickening of a wall or patol. education in its gleam, napr, a tumor.

By means of a tomography in a side projection divertikulopodobny protrusions of a back wall of T come to light., acquiring gear


Fig. 3. The tomogram of a chest part of a trachea of the patient with a tumor of a trachea (a direct projection): the arrow specified the roundish shadow of a tumor narrowing a gleam of a trachea.

contour. On the tomogram shadows of the educations narrowing a gleam of T are well visible. (fig. 3). For a research of an outer surface of a wall of T. apply a tomopnev-momediastinografiya (see Mediasti-nografiya) with administration of gas in paratracheal cellulose. In the absence of commissural or tumoral process in paratracheal cellulose on the tomogram gas comes to light in the form of the light thin strip shrouding walls of T. outside. For the purpose of receiving a contour of an inner surface of a wall of T. apply a contrast planimetric trakheografiya with pristenochny distribution of a contrast agent. In the presence patol. having formed a niya in a gleam of T. defects of filling and patol are accurately visible. narrowings of a gleam of T., and also the so-called symptom of a flow comes to light. With the help rentgenol. narrowing or expansion of a gleam of T is possible to define researches., a shadow of the new growth, its size, contours, a form, germination of a tumor in paratracheal cellulose. At a tracheostenosis it is possible to establish narrowing of a gleam of T., at Krom it quite often gets a form of hourglasses. In differential diagnosis of character of a tracheostenosis studying of contours of stenosed sites, and also morfol is important. research of biopsy material.

Pathology

Pathology of T. includes malformations, damages, diseases and tumors.

Malformations of T. can arise both as a result of disturbance of an embryogenesis of respiratory system, and as a result of inborn inferiority of elastic and muscle fibers of a wall of T., leading to emergence patol. educations in the post-natal period.

An agenesia — a rare malformation of T., at Krom it comes to an end blindly, without being reported with bronchial tubes. Bronchial tubes at the same time open in a gleam of a gullet. Heavy respiratory disturbances from the first hours of life of the child result in need of performance of a trakheo-bronkhoskopiya, on the basis of results a cut and make the diagnosis. Patients with an agenesia of T. are almost impractical.

Inborn stenoses subdivide on the compression, caused pressure upon T. an abnormal vessel, an inborn cyst or a tumor of a mediastinum, and the occlusive, caused by existence obstacles in T. Occlusive stenosis of T. it can be caused by a malformation of cartilages, as a result to-rogo on a part of an extent of T. has the form of the narrow tube deprived of a webby wall. Sometimes existence of a vnu-tritrakhealny partition is the reason of a stenosis. The leading symptom of a stenosis (see Trakheo-sgpenoz) is the spgridor (see), expressiveness to-rogo depends on extent of narrowing of T. In diagnosis results of roentgenoscopy, a tomography and trakheobronkhoskopiya have crucial importance. Treatment depends on localization, extent of narrowing and extent of a tracheostenosis. In the presence of an inborn intra-tracheal membrane its removal via the bronchoscope is possible. The limited circular stenosis can try to be buzhirovat, however it is more preferable to make a circular resection of T. with imposing of an anastomosis the end in the end.

Peculiar type of an inborn stenosis of T. it can be caused by a hypoplasia of its wall with absence on a bigger or smaller extent of cartilages. The respiratory disturbances in this case caused by reduction of a gleam of T. during a breath, amplify at concern of the child, crying, cough and exercise stresses. This defect is diagnosed by means of a trakheobronkhoskopiya, in time a cut find lack of cartilages on the limited site and reduction of a gleam of T. during a breath or cough; by means of a trakheobronkhografiya specify localization and extent of narrowing. In some cases in process of growth of T. relative degree of such stenosis can decrease therefore all attempts of its operational correction are recommended to be made at children not earlier than

5 — 6-year age. The exception is made by patients with the expressed respiratory insufficiency, the cut is the reason a stenosis.

The forecast at an inborn tracheostenosis depends on its character and the general condition of the child. In most cases stenosis of T. it is possible to eliminate by means of an operative measure.

Inborn tracheal fistulas are quite often observed in cervical part T. also treat group of branchyogenic fistulas (see. Branchyogenic cyst). Incomplete disappearance of branchial apertures is the cornerstone of them. Whistle for T. can be outside and internal, full and incomplete. Treatment of outside fistulas consists in their excision and plastic closing. Incomplete internal fistulas of treatment do not demand. Tracheosesophageal fistulas carry to malformations of a gullet (see the Gullet, malformations).

Cysts. In a trachea the paratracheal cysts resulting from disturbance of its chondrogenesis occasionally meet. At an underdevelopment of separate cartilages of T. her mucous membrane can evaginirovat in places of the broken cartilaginous framework. During the subsequent periods of an embryogenesis these sites can turn into paratracheal cysts. Paratracheal cysts of T. can arise also at an otshnurovka of internal branchyogenic cysts. At breath in the conditions of the complicated exhalation internal branchyogenic cysts can stretch air and turn into an air cyst — the tracheoaerocele. Abnormal branching of T. V of these cases from a trachea is other origin of paratracheal cysts, its bifurcations are higher, the so-called t departsthe rakhealny bronchial tube which is quite often coming to an end with kistoobrazny expansion to-ry can otshnurovatsya from T. with formation of a cyst of a mediastinum (see Bronchial tubes). Wedge, displays of cysts of T. depend on degree of a prelum of T. and disturbances of breath. The diagnosis is made on the basis rentgenol. inspections and trakheobronkhoskopiya. Treatment of cysts of T. operational. The forecast in uncomplicated cases favorable.

Expansion and diverticulums have in a basis decrease in a muscular and elastic tone of a wall inborn (or acquired) character. Rather seldom the inborn underdevelopment of cartilages meets, muscular tissue and an elastic basis of a tracheobronchial tree, a cut it is shown by softness of cartilages and decrease in a tone of a webby wall — a trakheobronkhomalyation. At this state under pressure of inhaled air the pliable wall of a trachea and bronchial tubes stretches, and the gleam of a tracheobronchial tree considerably increases in comparison with norm, causing development of a tracheobronchomegaly (see Bronchial tubes). At limited defeat of T. there can be protrusions of its wall — diverticulums (see the Diverticulum), to-rye are formed at tussive pushes (pressure diverticulums) or by retraction of a wall by cicatricial process from the outer side of T. (traction diverticulums). Pressure diverticulums are usually located on a back or posterolateral wall of T. Traction diverticulums have an appearance of the funneled poles which are located usually between rings, T. Divertikul located above bifurcation of T is more often in lower parts. on its right wall, arises from a rudimentary tracheal bronchial tube and is called an inborn diverticulum of T. At expansion and diverticulums of T. patients complain hl. obr. on constant cough of the barking or vibrating character, it is frequent with a purulent phlegm; tendency to acute respiratory diseases is noted. Diverticulums of T. well come to light at a trakheografiya. Local single diverticulums are subject to a resection.

Damages. The opened and closed T. Razlichayut's damages damages of cervical and chest part T are possible. Wounds of T. can be getting and not getting, blind and through, with damage and without injury of nerves and large vessels (see Wounds, wounds). Gunshot wounds of T. seldom happen isolated, mostly they are combined with damage of the vital next bodies. One of the main symptoms of an injury of T. the hypodermic emphysema (see) necks which was more expressed at the closed damages is. Bleeding in a cavity of T. is followed by constant cough, the bubbling breath and a pneumorrhagia. The aphonia is sometimes observed (see).

Diagnosis of damage of T. it can be in most cases established at external examination. In the presence of a wound in a lower part of a neck, from a cut foamy blood, or cough with release of blood (follows at the closed injuries of a neck), and also the phenomena of disturbance of breath it is possible to assume the getting damage of T. At indications apply a trakheobronkhoskopiya, radiological and other methods of a research T.

Treatment at wounds of T., especially fire, consists in primary surgical treatment of a wound with audit of the wound channel to the place of damage of a wall of T. As acute management at the getting wound of T. the tracheostomy tube is entered into a trachea via the wound channel; however in the subsequent make a typical tracheostomy as soon as possible (see). At the closed damages of T. carry more often out conservative treatment (rest, cold, use of antibiotics, inhalations, etc.) i AT disturbance of breath resort to a tracheostomy.

The forecast at the isolated injury of T. both timely and correct treatment favorable is more often. At simultaneous damage next to T. bodies (large vessels, gullet), development of asphyxia forecast serious.

Foreign bodys of a trachea — cm. Foreign bodys.

Diseases. Acute and hron. inflammations of a mucous membrane of a trachea (see Tracheitis) are the most frequent nonspecific inflammatory diseases of T. Acute tracheitis usually is continuation

of an acute inflammation upper dy

hatelny ways, most often acute laryngitis. Also the phenomena of a tracheobronchitis and a laryngotracheobronchitis are quite often observed. At acute tracheitis pristupoobrazny cough, is noted especially at night, to-ry arises even at insignificant quantity of a phlegm in T. also happens especially painful at localization of an inflammation in the field of bifurcation of a trachea. Changes in lungs are absent. The phlegm in the beginning viscous, scanty, then more plentiful, gains mucous character and begins to be expectorated easier. Hron. tracheitis is shown by constant cough with allocation of a slizistognoyny or purulent phlegm, sometimes with a smell. The diagnosis of tracheitis is established at a laringotrakheoskopiya taking into account complaints of the patient.

Treatment acute and hron. tracheitis — see Tracheitis. At treatment of tracheitis take necessary measures not to allow complications — distribution of inflammatory process on bronchial tubes and lungs.

The acquired stenoses of a trachea (see the Tracheostenosis) can be caused by inflammatory processes of T., existence in it of a foreign body or a tumor it is (extremely rare), and also cicatricial changes in a wall of T. (scleroma, syphilis, etc.), or pressure upon T. outside (retrosternal craw, aortic aneurysm, tumor of a front mediastinum, etc.). Wedge, manifestations of a stenosis of T. hl consist. obr. in disturbance of breath up to asphyxia (see). Treatment operational.

Tuberculosis of a trachea is shown by education in a mucous membrane of hillocks and flat superficial ulcers, to-rye are localized in cervical part T. or in the field of bifurcation. Along with tubercular ulcers diffusion catarral tracheitis is observed. Less often tubercular infiltrates, hl meet. obr. in a webby wall of T., and also opukholepodobny tuberculomas (see Tuberculosis of a respiratory organs).

Syphilis of a trachea is observed in the tertiary period of a disease. At the same time there are gummous infiltrates which are exposed to disintegration and an ulceration (see Syphilis). Ulcers quite often are complicated by a perichondritis and a necrosis of cartilages. Scarring of ulcers leads to formation of the characteristic hems which are pulling together fabric in the form of intertwining tyazhy and crossbeams. Much more rare in a wall of T. there is a syphiloma. Disintegration of a gumma can lead to perforation of T., to peritrakhealny abscess, a purulent mediastinitis, formation of tracheosesophageal fistula (see the Gullet) and also to cause fatal arrozivny bleeding from a large vessel (an upper vena cava, an aortic arch, an anonymous artery).

The scleroma of a trachea (see the Scleroma) develops in most cases as a result of distribution on a trachea of a scleroma of a throat and is observed in its upper part. The scleroma is shown by formation of the dense flat infiltrates raising a mucous membrane of T., is more rare than tumorous protrusions.

Tumors. Distinguish primary and secondary tumors of T. Primary tumors proceed from a wall of T., and secondary germinations of T are result. malignant tumors of the next bodies — throats, a thyroid gland, bronchial tubes, a gullet, a thymus, limf, nodes of a mediastinum. In a wedge, practice primary tumors meet less often than secondary.

Over 20 types of primary benign and malignant tumors of T are known-. At children the most part of tumors is benign, and at adults benign and malignant tumors meet approximately identical frequency.

From benign tumors of T. at children's age more than a half make papillomas (see Papilloma, a papillomatosis), fibromas (see Fibroma) and ge-ma.ngioma meet less often (see the Hemangioma). At adults papillomas, fibromas, kartsiioida prevail (see). Rare benign tumors of T.

a leiomyoma (see), the myoblastoma, a lymphoma (see), limf an angioma (see), a neurinoma (see), a chondroma (see), a lipoma are (see). Papillomas more often happen on the wide basis, a consistence their rather dense. On a surface of papillomas there can be nipples reminding a cauliflower or a cock comb — so-called papillary fibroepitheliomas. At adults of papilloma malignancies can be exposed. Fibromas of T. can have the wide basis or a narrow leg, are not inclined to a malignancy. Hemangiomas of T. — the soft tumors of blue-crimson color which are easily bleeding, often multiple. Carcinoids usually have a smooth and brilliant surface of red color without sites of a necrosis and ulcerations. The tendency of carcinoids to a malignancy and a recurrence after removal is small. Benign tumors of T. can clinically be shown by cough, feeling of a foreign body in a trachea, sometimes difficulty of breath. Perhaps (especially at children) sudden closing with a tumor of a gleam of T. with development of asphyxia. Treatment of benign tumors (as well as malignant — see below) operational, results of treatment in general good.

Primary malignant tumors of T. make about 0,1 — 0,2% of all cases of malignant tumors. The majority them proceeds from back and side walls of T. The most frequent malignant tumor of T. the tsilindroma is (see). Planocellular cancer is less often observed (see), is even more rare — sarcoma (see), a lymphosarcoma (see) and a gemangioperitsito-ma (see). Tsilindroma more often is at women. Tsilindroma represents a limited tumor of a dense consistence with smooth or, more rare, an ulcerated surface. The tumor often sprouts all layers of a wall of T. (fig. 4) and quite often adjacent bodies — a thyroid gland, a gullet. Metastasises tsilind-rums in lungs, limf, nodes of a mediastinum, a brain appear late — sometimes in 10 — 15 years after detection of primary tumor in T.

Planocellular cancer of T. it is observed twice more often at men, than at women. Macroscopically the tumor can be infiltrative, knotty or polipovidny. The infiltrative growth form is characterized by diffusion germination of a wall of T. with late emergence of disturbances of breath and an ulceration. At a knotty form the tumor happens small - or krupnobugristy, sometimes has an appearance of a cauliflower. Polipovidny cancer of T. can remind


Fig. 4 macroscopically. Macrodrug of a tsilindroma of a trachea (cross section): 1 — the exophytic growths of a tumor which are sharply narrowing a gleam of a trachea; 2 — endophytic growths of a tumor in the form of a massive peri-tracheal node; 3 — a cartilaginous ring of a trachea.

papilloma of ii in this case crucial importance in differential diagnosis gets microscopic examination of biopsy material. All cancer tumors gradually sprout a wall of T. also go beyond its limits, and an extra-tracheal part of a tumor can be more intratracheal.

A wedge, manifestations at malignant tumors of T. are more expressed, than at high-quality. Along with cough and feeling of a foreign body in a trachea the pneumorrhagia is quite often noted; during the narrowing of a gleam of T. on 2/z and more an asthma, a stridor, change of a voice join. Complications at malignant tumors of T. in most cases asphyxia, pneumonia or bleeding are, to-rye often lead to the death of patients.

Diagnosis of tumors of T. the hl is based. obr. on results rentgenol. researches and trakheoskopiya with a biopsy; in nek-ry cases data tsitol matter. researches of a phlegm and laringoskopiya. At differential diagnosis it is necessary to exclude a tumor of T. at patients with an asthma of not clear etiology and bronchial asthma.


Fig. 6. The diagrammatic representation of some options of recovery of a respiratory way after a resection of bifurcation of a trachea: and — a trachea and bronchial tubes before operation (the resected site is shaded); — d — options of suture after a resection of bifurcation of a trachea.


Treatment of tumors of T. operational. At many tumors their radical or palliative removal is possible via the bronchoscope by means of ultrasound (see. Ultrasonic therapy), diathermocoagulations (see), a cryolysis (see the Cryosurgery), laser photocoagulation. Widely apply also open operational excision of tumors with a window or circular resection of T. Radiation therapy (see) matters an additional method after operative measures concerning malignant tumors. After radical malignant tumors operation

more than 5 years there live about 1J3 operated patients. Rather slowly the tsilindroma progresses — sometimes patients live 10 — 15 years.

Operations

Till 60th 20 century of operation on T. were, as a rule, carried out on its cervical part and were limited to small endoscopic interventions. Subsequent progress in the field of surgery of T. it is connected with achievements in development of the endoscopic equipment, anesthesiology and thoracic surgery. Particularly important methods of a resection of various departments of T became. with recovery of a respiratory way.

Indications to operations on T. its ruptures and wounds, tumors, not tumoral stenoses of various etiology, diverticulums, fistulas are. After injuries and in cases of tumoral and not tumoral stenoses with disturbance of breath there can be indications to urgent operative measures.

The main endoscopic operations on T. bougieurage of cicatricial stenoses, palliative and radical removal of benign and malignant tumors, removal of granulyatsionny fabric and ligatures after already performed open operations are. Endoscopic surgery of T. demands injection ventilation of the lungs (see. Artificial respiration) and existence of the equipment and tools for bougieurage (see), diathermocoagulations (see), a cryolysis (see the Cryosurgery), and also influences by ultrasound (see) and the laser (see) via the bronchoscope. From open trachea operations tracheotomy (see), a tracheostomy (see), fenestrated and circular re

a zektion (see), and also plastic surgeries at a cicatricial and expiratory stenosis are most frequent (see the Tracheostenosis) and various fistulas (see). At open operations on T., the demanding its broad opening or crossing, for ventilation of the lungs use system the shunt — breath: the endotracheal tube from an operational wound is entered into a caudal piece of T. or a bronchial tube and then connect it to the narcotic device, separating a breath and exhaled (fig. 5). Long breaks in ventilation of the lungs (10 — 12 min.) are possible during the performance of operation in the conditions of hyperbaric oxygenation (see).

Quick accesses to cervical and upper chest to parts T. are a median cervical section or, better, vorotnikoobrazny time -


Fig. 5. The diagrammatic representation of system the shunt — breath, applied to ventilation of the lungs at open trachea operations: 1 — a cranial piece of a trachea; 2 — area of damage of a trachea; z — a caudal piece of a trachea; 4 — the endotracheal tube established over bifurcation of a trachea; 5 — the tubes going from the narcotic device; shooters specified the direction of the movement of respiratory mix.

a cut over jugular cutting of a breast with crossing of front muscles of a neck. Upper and average departments of chest part T. bare by a full or partial sternotomy. Access to a lower part of a chest part and bifurcation of T. the back or posterolateral thoracotomy is (see). After window resection defect in a wall of T. close seams, to-rye impose in slanting or cross to axis T. direction. A circular resection finish with imposing of an anastomosis the end

in the end. For suture on a trachea use thin threads of not races-sasyvayushchiyesya (No. No. from 0 to 4) or, better, the resolving synthetic material. Seams carry out through all layers of a wall of T., but it is optional to take a mucous membrane. During the use of not races-sasyvayushchegosya of a suture material all nodes are tied outside, out of a gleam of T. (see Seams surgical). After a resection of bifurcation of T. for recovery of a respiratory way

use various difficult ways (fig. 6). During operation for malignant tumors of edge of the resected piece of T. subject urgent gistol. to a research to be convinced of radicalism of the carried-out intervention.

Plastic surgeries at cicatricial stenoses of T. consist in excision of hems, recovery of a gleam, temporary introduction of endoprostheses. At patients with an expiratory stenosis strengthen the weakened webby wall bone transplants, a fascia, an aponeurosis (see. Plastic surgeries).

Prosthetics of T. is developed not enough. The encouraging results are yielded by use of sili-game-dacron prostheses.

Possible complications after operations on T. hl are. obr. effects of insolvency of seams: hypodermic and mediastinal emphysema (see), a mediastinitis (see), an empyema of a pleura (see), pneumonia (see), arrosive bleeding (see) from a brachiocephalic trunk, and also development of granulyatsionny fabric and stenosis of T.

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A. G. Likhachev; V. P. Bykova (stalemate. An.), S. M. Krivorak (malformations), N. V. Krylova (An.), M. I. Perelman (Torahs. hir.), And. X. Rabkin (rents.).

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