tracheia (arteria) a windpipe + stoma of companies, an opening] — the operation consisting in a section pe
a redny wall of a trachea with the subsequent introduction to its gleam of a cannula or creation of an ostomy for ensuring breath or carrying out endotracheal and endobronchial diagnostic and medical manipulations.
T. is one of the most ancient operations. In the second half of 20 century of the indication to it considerably extended. If before T. did generally at a stenosis of a throat (see the Laryngostenosis) and tracheas (see the Bang about a stenosis), in modern practice make it in some cases at an anesthesia, resuscitation, after brain, lungs, heart, trachea, gullet operations, at a craniocereberal injury, spine injuries, a thorax, disturbances of cerebral circulation, poisonings, poliomyelitis, tetanus, etc. for the purpose of ensuring passability of respiratory tracts and an opportunity to carry out artificial ventilation of the lungs (see. Artificial respiration).
Depending on indications of T. can be emergency and planned. Widespread introduction in a wedge, practice of a direct laringoskopiya (see), an upper trakheobronkhoskopiya (see Bronkhoskopiya) and an endotracheal intubation (see the Intubation, tracheas), carried out under anesthetic, led to sharp reduction of number of the emergency T.
For T., except the tools used at tracheotomy (see) tracheostomy cannulas are necessary. There are more than 30 types of cannulas (fig. 1), to-rye make of metal, plastic, rubber, rubber, glass, etc. Most the metal cannula of Lyuer consisting from outside and the internal tube and a mobile guard which is freely inserted into it and taken, and also similar were widely adopted it on a design plastic rigid and thermoplastic cannulas. Apply also tracheostomy tubes of a special purpose: the shortened straight lines — for suction of a secret from a trachea, extended flexible — for elimination of a stenosis in a chest part of a trachea, with inflatable cuffs — for creation of tightness between a tube and a wall of a trachea at artificial ventilation of the lungs. And convenient soft thermoplastic tubes from areactive polymers are the most qualitative. At the choice of a tracheostomy cannula in each case it is necessary to consider age and a sex of the patient, the sizes of a trachea, the reason and purpose T.
T., as a rule, make in the operating room, whenever possible under a nn-tubatsionny anesthesia (see. Inhalation anesthesia). Position of the patient on the operating table and technology of operation until introduction of a cannula same, as at tracheotomy (see).
The gleam of a trachea (see) is opened with longitudinal or cross section, sometimes create an opening in the form of a round window (fig. 2). Insert into it a trakheorasshiritel, and having once again convinced that the gleam of a trachea is opened, carefully enter a cannula (kanyulyation), keeping a guard at first in the sagittal plane, and then transferring it to frontal. For prevention posleoperatsion-
the leg of a stenosis of a trachea and the chronic kanyulenosi-telstvo connected with it usually carry out a section of a trachea and introduction of a cannula at the level of the second - the third - chetver - that cartilages of a trachea. The skin wound is narrowed several seams, the cannula is strengthened on a neck tapes.
Fig. 1. Main models of tracheostomy cannulas: and —
a metal cannula of Lyuer (1 — an internal tube, 2 — a mobile guard); — a rubber cannula (1 — an inflatable cuff, 2 — the limiter, z — a tube for inflation of a cuff, 4 — a tube for carrying out medical manipulations); in — the extended flexible metal cannulas of Keniga (1) and Bruns (2); — a plastic cannula with an inflatable cuff (1 — a tube for inflation of a cuff, 2 — the limiter).
The classical T described above. allows to create the unstable tracheostoma functioning only in the presence of the cannula entered into a trachea. A persistent tracheostoma, edges could function also without cannula, create, sewing the mobilized edges of a skin wound with edges of a dissect trachea. Option of such operation is the so-called trailer tracheostomy which is carried out at a laryngectomy (see). At this operation the trachea is completely crossed and its distal end is sewed in a wound over jugular cutting of a breast. Also other plastic ways of formation of the gaping tracheostoma are offered. At Byerk's way, the gained nek-swarm distribution at adults, an ostomy is created by means of the rag found from a front wall of a trachea with the basis turned caudally. The free edge of a rag is hemmed to skin so that danger of loss of a cannula in pretrakhealny cellulose is prevented and there is an opportunity to breathe through an ostomy without cannula. The way of windowing of a trachea consists in creation in a front wall of a trachea of the gaping ostomy covered by the skin valve.
Peculiar type of T. the transdermal puncture mikrotrakheosto-miya is (trakheotseitez), at a cut in a trachea by a puncture of front its wall (on a neck) enter a thin tubule for instillation of pharmaceuticals and suction of a secret.
At T. the same difficulties, operational mistakes and complications can be observed, as at tracheotomy, and also those, to-rye are connected with formation of a tracheostoma and introduction of a cannula. The rough and forced introduction of a tracheostomy tube quite often is followed by an injury of surrounding fabrics, bleeding (see), a rupture of walls of a trachea with the subsequent its deformation and a stenosis. Cases of introduction of a tracheostomy cannula to peritracheal cellulose, and also between a mucous membrane of a front wall of a trachea and its cartilages are known (fig. 3, a).
In the postoperative period on average at 10 — 15% of patients (is more often after the emergency T.) early and late complications are observed. The considerable number of complications results from obstruction of a cannula (fig. 3,6), discrepancy to her trachea on length, diameter or curvature (fig. 3, e), the wrong provision of a cannula in a trachea (fig. 3, d), its shifts, loss, a vklineniya in the right primary bronchus, uses of a faulty cannula, etc. Thereof the tracheomalacia and a necrosis of a wall of a trachea with formation of tracheosesophageal fistula (see), arrozivny bleedings quite often develop (see the Arrosion), granulations plentifully expand (see Granulyatsionnaya fabric); more often than at tracheotomy, suppurations of a wound (see Wounds, wounds), emphysema of soft tissues and a mediastinum (see Emphysema), an atelectasis of a lung (see the Atelectasis), aspiration pneumonia (see), etc. are observed.
All patients after T. need careful leaving (see Patient care) and treatment of a basic disease. The tracheostoma should be considered as a wound, and all manipulations, related (bandagings, change of a cannula, aspiration of contents of a trachea), to carry out with observance of rules of an asepsis (see) and antiseptic agents (see). The internal tube of a cannula is periodically taken out and cleared of slime and various stratifications. The outside tube is changed seldom. If the ostomy was not created yet, then during the replacement of an outside tube there can be difficulties therefore the patient is stacked as at operation, the wound is parted with hooks and only after it replace a tube.
Decannulation (removal of a tube from a trachea) is made after recovery of passability of a throat and a trachea, i.e. after emergence in a sick voice and a possibility of breath at the closed cannula. In avoidance hron. kanyulenositelstvo, especially at children, take a cannula as soon as possible, sometimes already on second day after operation. Quite often the tube is taken with great difficulty. In such cases for simplification of decannulation prepost antiinflammatory, resorptional therapy, bougieurage, excise granulations; in some cases the tube is taken under anesthetic. The tracheostoma after removal of a cannula is usually closed independently, less often it is closed in the operational way.
At expressed patol. changes of a trachea resort to spetsi-
Fig. 2. The diagrammatic representation of formation of a tracheostomy opening in the form of a round window by excision of a front wall of a trachea: 1 — a cricoid; 2 — the left share of a thyroid gland; z — the excised fragment of a front wall of a trachea; 4 — an isthmus of a thyroid gland.
to alny, including operational methods of its recovery (see the Tracheostenosis).
Bibliography: Blackamoors D. A. and Iza
of Fig. 3. The diagrammatic representation of some complications of a tracheostomy (on a sagittal section of a trachea): and — introduction of a cannula at not dissect mucous membrane, as a result ^чего the cannula gets between a mucous membrane and cartilages of a trachea;
— inflatable cuffs it is broken off, its end fell down and closed a gleam of a cannula; in — deformation of a trachea owing to discrepancy of curvature of a cannula and a trachea; — the wrong provision of a cannula at which its lower end injures a back
wall of a trachea.
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