tunnel laryngotracheal reconstruction

Due to trauma, surgery and other reasons, especially after surgery failed to correct, tunnel laryngotracheal reconstruction can significantly reduce the patient's pain, simplify postoperative care, and shorten the hospitalization date. The principle of tunnel-type laryngotracheal reconstruction is not to open the larynx, through the neck tracheal pupil, the introduction of the line with the dilator with the pull line and the dilator method, the step to enlarge the stenosis, the outer diameter of the last dilator designed The T-shaped silicone tube to be used has the same outer diameter. After expansion, the T-shaped silicone tube is pulled in, and the whole operation is completed in one go. Because the trauma is small, the reaction is light, the new sinus and the T-shaped tube are expanded in the same diameter, and the sealing effect is adopted. No matter whether the epiglottis function is normal or not, no nasal feeding is needed, and the treatment can be performed in the clinic. Curing disease: Indication 1. Traumatic laryngotracheal stenosis. 2. After surgery, including the stenosis caused by reconstruction of various types of laryngectomy. Contraindications 1. Acute traumatic period. 2. The stenosis is narrower than the length of 1cm. Preoperative preparation Learn more about the stenosis and use an indirect, direct laryngoscope or fiberoptic microscope. Iodine oil angiography is performed as necessary to determine the location and extent of the stenosis. Because the operation is performed under local anesthesia, it is necessary to make a good spiritual comfort and achieve full cooperation. For those who are nervous, sedative or sleeping pills should be given on the night before surgery. Surgical procedure Due to the narrowing of the throat, the normal respiratory passage is blocked, and the patient with the tracheal cannula should be removed first to expose the neck pupil. The skin was routinely sterilized and anesthetized once with 1% tetracaine into the pupil. Such as reaction coughing and coughing out secretions, can attract clean, patients can be replenished after being quiet, and routinely spread towels, infiltration anesthesia. The compounding agent was coated with the above cotton seeds, and the stenosis was left in place for a sufficient anesthesia. 1. The incision is not required to be incision due to tunnel operation. For example, if wearing a 10mm tracheal tube, the above-mentioned pupil should be cut open from the cannula, usually cut with a high-frequency electric knife to avoid hemostasis. . For ease of operation, the mastoid spreader can be used to support the pupil. 2, the introduction of the line with the dilator at this time can be into the larynx into the inducer, narrow and light, can be used catheter; heavy can be used stainless steel wire. The above-mentioned cotton wool made of stainless steel wire can also be used as an inducer, and after being fully anesthetized for a while, it is further extended to enter the pharyngeal cavity, and its end is bent into a small circle, which can be threaded. The head line of the wire expander is inserted, so that the patient opens the mouth, pushes the stainless steel wire, can see the cotton roll, and the assistant uses the hemostatic forceps to clamp the pull out of the outlet, that is, bring out the expander. 3. Pulling the dilator to expand the stenosis The diameter of the dilator is from 6 mm, each incrementing by 1 mm, the largest one is equal to the outer diameter of the T-shaped silicone rubber tube, and every other one is made into a gear shape, and the tip is ground into a blade. When the puller is too narrow, it is more laborious. The assistant should extend the finger to the pharynx, and tighten the outer line with one hand. The finger is used to increase the tension of the line and push the dilator through the narrow part. After all the dilators have passed, do not rush to draw the line, you can attach a spare on the tail line, pull the exit. After reviewing, it is found that when the length of the T-shaped tube is not suitable, the T-shaped tube can be pulled out, and the modified T-shaped tube is re-pulled by using the spare line. 4, measuring the length of the T-shaped tube indwelling can use the catheter or the above-mentioned stainless steel wire cotton, from the neck into the throat, the assistant through the nasal cavity into the optical fiberscope to observe, leaving the correct position. When the tip of the catheter or the cotton wool reaches 1 mm on the chamber, if the ventricular band is unclear, the sacral cartilage can be used as a marker. Below the upper edge, the surgeon can use the hemostat in the lower neck. Clamp the catheter or the cotton swab and pull it out. You can trim the T-tube according to this section. 5. Incorporate the T-shaped tube into the T-tube puller with the dilator tail. If there is no retractor, the thick wire can also be used for pulling through the upper end of the tube. The surgeon clamps the top of the upper branch tube with a hemostat and pushes it upward from the pupil. The assistant pulls in the mouth and pushes up and pulls up to pass the stenosis smoothly. If you simply send it from the lower mouth, it is likely that the hose in the narrow part is curled and cannot be properly placed. After the upper branch is fully inserted, the surgeon can use the hemostat to clamp the end of the lower branch, and the hose is crimped and squeezed to expose the lower edge of the pupil, and then can be inserted into the lower branch tube, and in the direction of the trachea, the T-shaped tube. 6. Review the T-tube indwelling height. The T-shaped tube measured and trimmed according to the above method may not be completely conformed after being incorporated. It must be re-examined with a fiberoptic mirror. The height should be 1 mm on the chamber, and the operation can be completed. If the height is too low, the T-shaped tube must be pulled out. After re-trimming, use the spare line, re-incorporate according to the above operation method, and check the height again. After the above requirements are met, the spare line can be removed and the operation can be ended. If the suture is pulled, after the clear placement is appropriate, the suture can be cut at one end and pulled at the other end.