tracheoesophageal shunt

Tracheal esophageal drainage (gracheoesophagealshuntprocedure) is a patient who loses the pronunciation function of total laryngectomy, and uses a button-like pronunciation device to perform second-phase or one-stage pronunciation reconstruction. The basic principle is to introduce the lung gas into the laryngeal and pharyngeal cavity through the branch established by tracheal esophageal artificial fistula, and to vibrate the mucosa. In order to prevent the occlusion of the artificial ostomy, the silicone tube can be embedded in the tracheal esophagus. On the way. There are many varieties of pronunciation tubes: blomsinger (1979) pronunciation tube, panie (1981) pronunciation button, singh (1988) valve button, etc., in which the blomsinger low-pressure flap-type pronunciation tube has a pedicled valve in the esophageal side wall. Usually closed, the pronunciation is open, and the airflow resistance is not large; the panje pronunciation button is a pair of flanged silicone tube, the esophageal side is a duckbill-type one-way valve, the tracheal end is open, and the esophagus side and the trachea side each have a flange. This type is small in size and has a large airflow resistance, but has little effect on respiration and cough; the short tube of the singh valve membrane is connected with a short silicone tracheal tube on the trachea side, which is open when inhaled, and unidirectionally ventilated when the sound is closed. Tube, when the patient speaks, the mouth can be blocked by hand. Clinical use of the blomsinger pronunciation tube. Treatment of diseases: laryngeal cancer Indication 1. After total laryngectomy, the esophageal sound training failed or the artificial throat and electronic throat were not satisfied. 2. The patient's lung function is still good, he can clean the pronunciation tube by himself, and there is no local tumor recurrence. Preoperative preparation Esophageal inflation test should be performed before surgery to understand the patency of the pharyngeal tube segment and the function of the pharyngeal muscle. Surgical procedure 1. The patient takes the supine pad and the shoulder position. 2. Insert a silicone tube or esophagoscope with a diameter of 1.0-1.5cm through the mouth. When the front end of the silicone tube or esophageal mirror reaches the esophageal entrance, the end of the silicone tube can be touched at the neck tracheostomy or see Light to the esophagoscope. Under the guidance of this light, in the posterior wall of the trachea in the tracheostomy, 5~7mm from the junction of the skin and mucous membranes, use the small round knife or the 18th vein needle to cut or puncture in the area, through the tracheal esophagus Enter the endoscope cavity of the silicone tube or esophagus mirror. The incision area is located at 12 o'clock, and the straight incision is about 0.8 to 1.0 cm long. 3. From the silicone tube or esophagoscopy endoscopic and incision or venipuncture needle tip, at this time the tracheal esophagus shunt has been formed. A catheter or polyethylene tube with a water sac is introduced through the incision or puncture, and the end of the water sac is placed in the esophageal cavity to prevent coughing. 4. The polyethylene tube or catheter with the water sac should be kept at the ostomy of the tracheal esophagus for 2 to 3 weeks, so that the ostomy of the branch is stable. After 5.2 to 3 weeks, the catheter or polyethylene tube was pulled out from the fistula, and the articulation tube was immediately placed through the fistula between the tracheal and esophagus, so that the esophageal side of the articulation tube entered the esophagus. The flap is fixed in the middle of the front of the neck. 6. Tracheal esophageal bypass ostomy can also be completed in the i-phase of total laryngectomy.