TRACHEOSTENOSIS

From Big Medical Encyclopedia

TRACHEOSTENOSIS [Greek tracheia (arteria) windpipe + ste-nos narrow; a synonym a stenosis of a trachea] — narrowing of a gleam of a trachea.

T. there is inborn ii acquired. Inborn T. it is observed seldom. It is a consequence of malformations of a trachea or is caused by squeezing by its abnormally developed vessels, increased twisted-point gland, an inborn cyst of a neck (see the Trachea, malformations).

Acquired by T. happens functional and organic.

Functional t r and-heostenoz. Reason functional T. usually relaxation or an atrophy perepon-is


Fig. The diagrammatic representation of changes of a gleam of a trachea at a functional tracheostenosis (an expiratory stenosis):

and — on a breath — on an exhalation, in — during cough; 1 — a webby wall of a trachea, 2 — a gleam of a trachea, 3 — cartilages of a trachea.

chato of a wall of a trachea after postponed respiratory inf. diseases or at emphysema of lungs. Narrowing of a gleam of a trachea in such cases happens only during an exhalation (a so-called expiratory stenosis, or dyskinesia of a trachea) when the webby wall sinks down in a gleam of a trachea (fig).

The main symptoms of an expiratory stenosis — the pristupoobrazny barking cough, short wind with the complicated exhalation, attacks of suffocation, sometimes with a loss of consciousness.

A crucial role in diagnosis expiratory T. play rentgenol. the research and a trakheoskopiya (see Laringoskopiya), at to-rykh comes to light retraction of a webby wall in a gleam of a trachea up to its full closing during a deep exhalation or cough. The available pathology can be documented by means of X-ray filming or filming via the bronchoscope.

At expiratory T. simplification of breath is reached by delay of an exhalation and an exhalation against artificial resistance. For this purpose patients exhale air through the compressed lips or through a narrow tube. Conservative treatment expiratory T. comes down to sanitation of a bronchial tree. Sometimes apply operational methods of treatment — strengthening of a webby wall of a trachea and primary bronchi bone transplants, a fascia, an aponeurosis.

The forecast at timely treatment, as a rule, favorable.

The organic tracheostenosis can result from operations on bodies of a neck, a long intubation of a trachea (see the Intubation), injuries of a trachea — mechanical, physical (a burn, radiation therapy) and chemical, inflammatory processes. On morfol. to signs he more often is granulyatsionny (owing to plentiful growth of granulyatsionny fabric) or cicatricial (owing to development of fibrous fabric). It is possible also so-called compression organic T., caused by a prelum of a trachea from the outside of the increased thyroid gland, tumors, the cysts increased limf, nodes, an aortic aneurysm. In a wedge, practice cicatricial the T most often meets. after a tracheostomy (see) and long subsequent artificial ventilation of the lungs (see. Artificial respiration). Narrowing of a gleam of a trachea at the same time is localized at the tracheostoma or at the level of an inflatable cuff or at the end of a tracheostomy cannula. To emergence of this type of T., to-ry it is observed at 2 — 3% of patients with a tracheostoma, difficult ways of a tracheostomy, creation of big fenestrated defects in a wall of a trachea, the inadequate diameter and curvature of a cannula, excess inflating of a cuff, inf promote. complications of a wound.

Wedge, manifestations organic T. depend on degree of a tracheostenosis. At a cicatricial stenosis the outer diameter of a trachea is reduced slightly, and the wall is sharply thickened due to growth of cicatricial fabric in a mucous membrane, a submucosal layer and the destroyed cartilages that causes narrowing of internal diameter of a trachea.

V. K. Trutnev and A. I. Yunina (1960) depending on degree of a tracheostenosis distinguish compensated, subcompensated and dekompensirovanny T. Compensated to T. (internal diameter of a trachea at adult patients more than 6 mm) the wedge, with impt about ma mi is not followed; subcompensated to T. (diameter of a trachea less than 5 mm) it is characterized by obstructive emphysema (see) with disorder of breath and blood circulation at the minimum loading; at a dekom-pensirovanny stenosis (diameter of a trachea less than 3 mm) join inf. complications, are observed disturbances of blood circulation at rest.

The main wedge, symptoms organic T. an asthma (see) with the complicated breath, stidor breath, hoarseness, cyanosis, disturbance of ventilation of the lungs I expectorations of a phlegm are. About three-dor (see) at rest happens, as a rule, only at reduction of diameter of a trachea to 3 — 4 mm. With a bigger diameter of a trachea breath is compensated in the course of slow formation of a stenosis, and the stridor arises only at a physical tension.

At patients with dekompensirovanny T. a ducking forward, the immovability of a throat, participation in breath of auxiliary respiratory muscles of a neck and breast attract attention.

Children with it is long to the existing T. lag behind in physical development owing to hron. hypoxias (see). Sometimes their deficit of the weight (weight) of a body is marked because of difficulties of meal (suffocation during food).

Diagnosis of T. the wedge is based on characteristic, symptoms and it is specified by means of special methods of a research. Treat them a tomography (see), a contrast trakheografiya (see the X-ray analysis), a laringoskopiya (see) itrakheos-to-piya (see Endoscopy). The endoscopic research conducted under anesthetic allows to specify anatomic features of T. and the condition of a mucous membrane of a trachea, from to-rykh in many respects depends to lay down. tactics. However it is dangerous at patients with dekompensirovanny in T. in connection with difficulties of their transfer into independent breath after artificial ventilation of the lungs. Therefore at a trakheoskopiya broaden with careful blocking area of narrowing, creating the best conditions for escaping of an anesthesia and the subsequent operation. Methods of a functional research — the spirography (see), pneumotachometry, a whole-body plethysmography (see) matter not so much for diagnosis of T., how many for assessment of dynamics of process.

Treatment organic T., as a rule, operational, carried out by means of endoscopic or open operations.

Endoscopic interventions are reasonable hl. obr. at a granulyatsionny stenosis, first of all at children. They consist granulations vykusyva-niy or photocoagulation, at a greasing with leaving in a trachea of an endoprosthesis at a distance for the term of not less than 1 month. At the same time appoint corticosteroid hormones.

Open operations at a stenosis of a cervical part of a trachea consist in excision of hems, plastics, imposing of a tracheostoma and introduction of an endoprosthesis. From different types of endoprostheses most widely apply the T-shaped tube from silicone rubber. After a sformirovaniye in a trachea of rather wide gleam the endoprosthesis is deleted, and an opening

in a front wall of a trachea if it does not begin to live independently, closed by means of plastics. Other type of open operation is more risky single-step circular resection of a trachea with imposing of a tracheal or laryngotracheal anastomosis. Important premises for success of this operation — lack of the expressed inflammatory changes in fabrics, through to-rye there will pass seams of an anastomosis. Resect zones of a stenosis and a tracheomalacia. At a stenosis of a chest part of a trachea method of the choice is the circular resection of a zone of a stenozirovaniye with imposing of an anastomosis; the local plastics is applied seldom. At impossibility of radical operations it is necessary to try to carry out a long tracheostomy cannula through the narrowed site of a trachea.

Treatment compression organic T. consists the education causing a prelum of a trachea at a distance.

The forecast at progressing T. without timely treatment very serious, especially at children, owing to narrowness of a gleam of a trachea at them and tendency of her mucous membrane to hypostasis. At adult T. can lead to death from asphyxia owing to a delay of a phlegm about narrowing.

Bibliography: And in and l about in and O. M. Experience

of carrying out operation on bronchial tubes and mediastinal segment of a trachea, Grudn. hir., No. 1, page 60, 1975; Petrovsky B.V., Perelman M. I. and Queens and I. S. Tracheobronchial surgery, M., 1978; Rabkin I. X. and

Yu d and e in K. F. Radiodiagnosis of post-tracheostomy stenoses, Grudn. hir.,'kya 5, page 83, 1974; Rabkin I. X., Feldman F. Ts. and Yu d and e in K. F. Radiodiagnosis of an expiratory stenosis of a trachea, Vestn. rentgenol. and radio-gramophones., No. 4, page 3, 1973; Tarasov D. I. Acute stenoses of a throat and trachea, M., 1965; X and t r about in F. M. Defects and cicatricial fusions of a throat, cervical department of a gullet, throat, trachea and technique of their elimination, M., 1963; Yu N and N and A. I., Injuries of bodies of a neck and their complication, M., 1972; From ura u d L. e. a. Traite-ment chirurgical des stenoses de la voie respiratoire apres reanimation, Chirurgie (Paris), t. 104, p. 74, 1978; Grillo H.C. Surgical treatment of postintubation tracheal injuries, J. thorac. cardiovasc. Surg., v. 78, p. 860, 1979;

Levasseur P. e. a. Les resections anastomoses de tra-chee pour stenoses tracheales non tumora-les, Chirurgie (Paris), t. 106, p. 109, 1980; Meyer R. New concepts in laryngotracheal reconstruction, Trans. Amer. Acad. Ophthal. Otolaryng., v. 76, p. 758, 1972.

M. I. Perelman.

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