Expanded polytetrafluoroethylene artificial trachea laryngotracheal reconstruction

When the laryngeal or trachea is caused by cartilage defects, the stenosis of the stent is lost. Although it can be formed by transplanting cartilage or periosteum, the operation is complicated and the success rate is low, and the expanded polytetrafluoroethylene artificial tracheal tracheal reconstruction is effective. Simple and easy, especially for the function of laryngectomy, due to infection, blood supply, etc., when the "new throat" cartilage is difficult to extubate, there is no other effective way, this rule can quickly restore the normal respiratory passage. Treating diseases: throat trauma Indication 1. Respiratory obstruction caused by loss of tracheal cartilage in the larynx and neck. 2. After the reconstruction of the laryngectomy function, the cartilage is too much or completely absorbed, resulting in a lack of stent and difficulty in extubation. Contraindications The lesion has been close to the tracheal ridge, or the lesion has been below the tracheal ridge. Preoperative preparation 1. Learn more about the condition and conduct a comprehensive physical examination, including heart, lung, liver and kidney function tests. 2. Indirect laryngoscope, direct laryngoscope and fiber bronchoscopy to understand the location, extent, extent and cartilage defect of the scar in the laryngotracheal tube. 3. Take the X-ray or CT scan of the lateral position of the larynx to understand the location, extent, extent and cartilage defect of the scar. 4. Tracheotomy is generally a tracheotomy for chronic laryngeal stenosis. If not, a lower tracheotomy can be performed first, followed by an angioplasty. If the tracheotomy position is high, the cut opening should be moved to the 4th to 5th tracheal rings first. 5. Tracheal endocrine culture and bacterial drug sensitivity test. 6. Prepare the skin in the neck. Oral rinse with a 1:1000 nitrofurazone solution. 7. Prepare, fasting, and injecting atropine before general anesthesia. 8. Do a good job of explaining the work, so that patients can understand the treatment of scar stenosis is difficult, complications may occur, the quality of the sound is not good, postoperative swallowing, and may require surgery. Surgical procedure It is completed in two steps. In the first step, the sinus can be formed by a T-shaped silicone rubber tube. If the diagnosis is due to a cartilage defect before surgery, the second step can be performed 2 to 3 weeks after the T-shaped silicone rubber tube is formed. Since it is judged whether or not cartilage defects are present, it is generally difficult to be used except for special X-ray equipment. Therefore, it is also possible to use the experimental diagnosis method, that is, the first step of the scar narrowing routine, and the T-shaped silicone tube is left for 8 months. During the period of indwelling, the patient's life is basically normal and generally acceptable. If the expiration is difficult, especially the probe with the same outer diameter as the T-shaped tube is expanded, the probe enters easily, the probe is pulled out, and the lumen collapses immediately, and the cartilage defect can be determined. The second step can be performed immediately. Cut the appropriate expanded polytetrafluoroethylene artificial trachea, except for the "new throat" cartilage loss, the length is generally more than 1cm narrower than the narrow. The "new throat" formed by the laryngectomy function can have a loud vocalization when the cartilage is missing, but it cannot breathe normally. If the "new throat" is fully extended, the breathing will return to normal, but the loudness will drop to "whispering", so try to restore normal breathing and keep a good voice. The method is that the indwelling height is slightly lower than the "new throat", so that it is not fully extended. How to find this height depends on repeated experiments. This step can only be used with T-shaped silicone rubber tube. Because the tube is easy to trim and flexible, it can be easily taken out. It can be used with a length of 1mm. Repeat the experiment to find out the height of both, and keep it for 1~2 weeks. The effect is stable, and this length is used to replicate the expanded polytetrafluoroethylene artificial trachea. According to animal experiments, it takes half a year for the expanded polytetrafluoroethylene to fuse with the tissue (the fibrous connective tissue protrudes into the porous polytetrafluoroethylene). Since the throat and trachea are moving parts, the fusion time is longer, so proper fixation is the key to success. The neck tracheal fistula is fixed as a fulcrum, which is safe, reliable and simple. If it is not up to its length, it should be trimmed slightly below the skin, so that it does not affect the suture. Where the diameter of the neck tracheal fistula is about 1.5cm, the side tube can be seamed with stainless steel soft wire to make it resemble the T-shaped silicone rubber tube, the length of the main tube and the side tube, and trimmed according to the above requirements, and boiled or autoclaved. After the sinus is numb and local anesthesia, the artificial trachea can be included according to the T-shaped silicone rubber tube. Where the neck tracheal fistula is thinner and the diameter is less than 1.5cm, it shall be made into a side column, that is, four holes with the same diameter of 0.5mm in the main pipe and the side column, and the corresponding holes shall be connected by stainless steel wire. Outside the small column, a small stainless steel piece with a thickness of 0.3 mm is prepared, and a small hole with the same distance from the main pipe and the small column is drilled. When wearing stainless steel wire, it can be placed outside the main pipe and the side small column to reinforce the expanded polytetrafluoroethylene tube. Before placement, the sinus should be surface anesthetized, and most should be pulled. The method is the same as the placement of the T-shaped silicone tube, but the main tube is temporarily separated from the side column (connected with stainless steel wire). When the main pipe is pulled into the trachea, the lower end is retracted into the trachea below the neck, then the side post is sent into the trachea, and the wire is tightened, and the twisted knot is tightened. The length of the small column should be measured and trimmed in advance so that it can reach the subcutaneous plane after tightening. Observe the ventilation condition. If it is normal, the neck pupil can be sutured immediately. It can also be sutured after several days. Local anesthesia can be performed by suturing the neck. First cut the skin around the neck to the skin, and sharply separate to the extent of the purse, turn the epithelium into the tracheal surface, suture the purse, then cut the lower flap, transfer to the neck, suture the wound, leave the drainage strip and Bandaging.