What is the best way to treat tracheal stenosis?

In real life, tracheal stenosis is very unfamiliar to many people. Tracheal stenosis is a respiratory disease. Tracheal stenosis can cause breathing difficulties and shortness of breath, which greatly affects the patient's normal life and work. Tracheal stenosis should be treated in time, and it can be treated with medication or surgery.

Causes

This disease is common after tracheotomy. When the tracheotomy is performed at a too high position and the first cartilage ring is damaged, it may cause cricoid cartilage erosion, inflammatory lesions and difficult-to-correct severe subcricoid stenosis. When the tracheotomy is performed, too much anterior tracheal wall tissue is removed, which may form a large amount of granulation tissue and fibrous scar tissue in the future. The tracheal tube compresses the anterior tracheal wall, causing the tissue above the incision to collapse inward, and the tube connected to the outside of the tracheal tube compresses the tracheal wall too much, causing tissue compression and erosion, which may form fibrous scar tissue in the future. In addition, if the balloon outside the tracheal tube used to seal the tracheal cavity is inflated too much and the pressure is too high, it may also compress the entire tracheal wall, causing tissue erosion and necrosis. In severe cases, annular scar stenosis may form in the future, or even tracheoesophageal fistula and tracheal innominate artery fistula may occur.

The mortality rate in the latter two cases is very high. Therefore, when performing tracheotomy and intubation, attention should be paid to the site of tracheotomy, not too much anterior tracheal wall tissue should be removed, the size and length of the tracheal tube should be appropriate, the balloon inflation pressure should not be too high, and the connecting tube should be light and soft to reduce the incidence of complications of tracheal stenosis.

Tracheal and bronchial stenosis are also common in airway lesions, such as benign or malignant tumors in the trachea and bronchi, inflammatory granulomas and foreign bodies in the airway; external airway compression, space-occupying lesions around the airway, such as esophageal cancer, thyroid cancer, abscesses, hematomas or gas compression; airway wall lesions, such as tracheal wall damage caused by radiotherapy for tracheal tumors, esophageal cancer or other chest tumors, tracheal softening and relapsing polychondritis, etc.

treat

1. Circular resection of the lesion and end-to-end anastomosis was the main treatment for tracheal stenosis in the past. Transbronchial electrosurgical or laser incision combined with balloon dilatation is safe, minimally invasive and effective.

2. For cases where the tracheal cavity is blocked only by granulation tissue, the granulation tissue can be removed through bronchoscope using cryotherapy or thermal ablation such as laser, high-frequency electrosurgical unit, APC, etc., or the trachea can be cut open and the granulation tissue can be scraped off under direct vision to ensure smooth ventilation.

3. For stenosis caused by softening of the tracheal wall due to long-term compression of tumors in adjacent organs, after relieving the compression, the softened area can be fixed with ribs to overcome the stenosis. A silicone stent can also be implanted in the trachea to relieve the stenosis. For emergency patients with large airway stenosis, a tracheal stent can be inserted first to relieve dyspnea, and then treatment can be directed at the cause.

4. For patients whose stenosis area is too long and not suitable for resection of the lesion and end-to-end anastomosis, a tube can be placed in the trachea and led out of the body through a stoma to relieve tracheal obstruction and ensure unobstructed breathing.

5. Resection and end-to-end anastomosis of tracheal lesions in infants and children must be performed with caution. Because infants or children can tolerate less tension on the tracheal anastomosis than adults, and because their tracheal lumen diameter is small and their tolerance to edema is poor, surgery should be postponed as much as possible.

6. During the treatment process, attention should be paid to anti-infection treatment. Infection can aggravate the degree of tracheal obstruction, increase the difficulty of treatment, and may also cause the risk of complete tracheal obstruction.

7. For patients whose tracheal tube has been removed and who no longer need mechanical ventilation therapy but whose tracheal stenosis is severe, tracheal reconstruction surgery is generally required. In cases where ventilation function has not fully recovered, conservative treatment measures such as regular tracheal dilation, tracheal reconstruction, intubation, or insertion of a ventilation tube in the narrowed segment to support the tracheal lumen can be used to maintain ventilation function and prolong life.

8. Other surgical methods used to treat this disease include endotracheal bougie dilatation, airway balloon dilatation, intratracheal laser technology, tracheobronchial stent technology, etc. The emergence of these technologies has made the treatment of tracheobronchial stenosis and occlusion simple and safe, with extremely significant therapeutic effects. If it is caused by scar lesions such as tuberculosis and trauma, the treatment is mainly based on bougie and balloon dilatation, and the insertion of foreign objects such as stents should be avoided as much as possible. If the trachea and bronchi are completely blocked, it is necessary to use laser to open the blocked airway part based on strict selection of indications, and then use bougie or balloon dilatation to maintain airway patency, or insert a replaceable airway stent such as a silicone stent according to actual conditions, and remove the stent as needed after the condition stabilizes. For tracheobronchial stenosis caused by malignant tumors, airway laser and airway stent placement are the main treatments. These methods can restore the ventilation function of blocked or narrowed trachea and bronchi in a very short time, significantly improve the patient's working ability, improve their quality of life, prolong survival time, and buy precious time for treating the primary disease.