Tracheal and bronchial stenosis

　　Patients who need tracheotomy surgery for tracheal and bronchial stenosis are prone to the following complications:

　　1, Subcutaneous emphysema:It is the most common postoperative complication, related to excessive separation of the soft tissue in front of the trachea, the external short and internal long incision of the tracheal incision, or the tight suture of the skin incision.

　　2, Pneumothorax:When exposing the trachea, excessive and deep separation downward may damage the pleura and cause pneumothorax.

　　3, Bleeding:Minor bleeding during surgery can be stopped by compression or filling the wound with gelatin sponge. If there is a lot of bleeding, there may be vascular injury, and the wound should be checked and the bleeding points ligated.

　　4, Difficulty in extubation:During surgery, if the incision site is too high, it may damage the cricoid cartilage, leading to subglottic stenosis after surgery. If the incision is too small, the tracheal wall may be pressed into the trachea when inserting the tracheal tube; postoperative infection and granulation tissue hyperplasia can all cause tracheal stenosis, making it difficult to remove the tube.

　　5, Tracheoesophageal fistula:Rarely. During laryngeal dyspnea, due to the negative pressure state in the trachea, the posterior wall of the trachea and the anterior wall of the esophagus protrude into the tracheal lumen. Cutting the anterior wall of the trachea may cause injury to the posterior wall.

　　Patients with tracheal and bronchial stenosis may exhibit varying degrees of dyspnea, which can be inspiratory or expiratory, or both. It is often accompanied by shortness of breath, wheezing, cough, and sputum production. Physical activity and increased respiratory secretions can worsen symptoms, and wheezing is common. Patients who have undergone tracheotomy and intubation and exhibit the aforementioned symptoms should first consider tracheal scar stenosis. Anteroposterior, lateral, and oblique tracheal断层 radiographs can clearly show the location, degree, length, and morphological changes of the stenosis.

　　The prevention of tracheal and bronchial stenosis mainly involves early detection, early diagnosis, and early treatment of primary diseases. Lesions occurring in the trachea and bronchi should consider the possibility of causing airway stenosis and take preventive measures against the occurrence of airway stenosis lesions in advance. During examination, although tracheal iodine oil contrast examination is valuable for diagnosing tracheal stenosis and determining the extent of stenosis, there is a risk of aggravating tracheal obstruction, which deserves attention. It should only be considered when other diagnostic methods are ineffective.

　　There are many causes of tracheal and bronchial stenosis, which can generally be diagnosed by the following examinations:

　　39. 1. X-ray:Tracheal tomography can detect stenotic trachea.

　　37. 2. Endoscopy:Can effectively detect stenotic tracheal and bronchial lesions.

　　35. 3. Tracheal iodine oil contrast examination:Although it is valuable for diagnosing tracheal stenosis and understanding the scope of stenosis, there is a risk of aggravating tracheal obstruction, which deserves attention.

　　For patients with tracheal and bronchial stenosis, reasonable diet is the key to disease recovery after surgery. Postoperative patients should prioritize liquid food while ensuring the body's nutritional needs. For patients with special requirements, it is recommended to follow medical advice for eating to prevent unexpected situations.

　　28. Depending on the cause, there are the following treatment methods for patients with tracheal and bronchial stenosis:

　　27. Circular resection and anastomosis at the distal end is the main treatment method for tracheal stenosis.

　　26. For cases where only granulation tissue blocks the tracheal lumen, granulation tissue can be removed by bronchoscopy or incised trachea under direct vision to scrape off granulation tissue, ensuring smooth ventilation.

　　25. For narrowing caused by long-term compression by adjacent organ tumors and softening of the tracheal wall, the narrowing can be overcome by using rib slices to externally support and stabilize the softened area on the basis of releasing the pressure.

　　24. For those with too long a narrow area that is not suitable for resection of the lesion and anastomosis at the distal end, a tracheal tube can be placed in the trachea, and the airway obstruction can be relieved by leading it out through an artificial opening, ensuring smooth breathing.

　　23. It must be cautious to perform resection and anastomosis on the distal ends of the trachea in infants and children. Because the tolerance of the distal anastomotic site in infants or children is lower than that in adults, and the tracheal lumen diameter is small, the tolerance to edema is poor, so the operation should be postponed as much as possible.

　　22. Pay attention to anti-infection treatment during the treatment process. Infection can aggravate the degree of tracheal obstruction, increase the difficulty of treatment, and may also cause the danger of complete tracheal obstruction.