rubcovyj i ekspiratornyj stenoz trahei

The trachea is a cartilaginous tubular body through which the inhalation and exhalation of air. It is located below the larynx and enters the main bronchi. Narrowing (stenosis) of the trachea may develop when scarring of the wall of the trachea, tumors of the thyroid gland compression of the trachea from the outside, in tumors of the presentation. Isolated scar and expiratory stenosis of the trachea.

Cicatricial stenosis of the trachea

It is characterized by the substitution of the structures of the wall of the trachea scar tissue, and loss of frame-based structures of the trachea. Most often the cause of this disease is prolonged pressure exerted on the wall of the trachea by cuffed endotracheal tube or tracheostomy cannula with prolonged artificial lung ventilation. All this leads to violation of blood circulation in the tissues and, accordingly, to growth of granulation tissue. If the damage to the trachea may develop purulent-necrotic process.

That is, the inflammatory process plays a significant role in the development of tracheal stenosis. In rare cases, the cause cannot be determined, then it is considered idiopathic. Usually the such stenosis etiology develops in middle-aged women. Dense keloid scar has a length of 1-3 cm and located in the adventitia (upper shell) of the upper third of the trachea.

The most complete classification of cicatricial stenosis of the trachea was proposed by doctor of medical Sciences, Professor V. D. Parsinen, according to which the stenoses are divided:

1. Localization. They can develop in the larynx with lesions of the vocal folds and the subglottic division of the cervical trachea, in verhnegrudnom, srednesrochnoi and abifurcation the trachea. It can be combined damage.

2. According to the etiology. Stenosis can be idiopathic, petrogeokhimicheskie, post-traumatic and postintubation.

3. As the prevalence. Allocate limited stenosis (up to 2 cm) and long (over 2 cm).

4. The degree of constriction. 1 the degree of stenosis – narrowing of the lumen of the trachea 13 of a diameter of the airway, stage 2 – narrowing from 1/3 to 2/3 of a diameter, grade 3 – narrowing of more than 2/3 of the diameter.

5. The anatomical shape of the lesion. It can be circular contraction, contraction of the anterolateral wall atresia.

6. The condition of the walls of the trachea. Isolated stenosis discovered tracheal stenosis with and without it. The discovered tracheal stenosis is underdevelopment of the cartilaginous skeleton and muscle tissue of the trachea.

7. The presence of a tracheostomy. A tracheostomy is an artificial opening in the outer derived the neck for breathing.

Expiratory stenosis of the trachea

Functionalnarrowing of the trachea and main bronchi is called expiratory stenosis. It is characterized by excessive immersion atonic membranous film in the lumen of the trachea during expiration and cough. Quite often amazed and main bronchi. There are primary and secondary expiratory narrowing (stenosis) of the trachea. The primary expiratory stenosis is the result of the nerve elements in the wall of the trachea by viruses and bacterial toxins of acute respiratory infections (acute respiratory diseases), the flu. Secondary stenosis develops emphysema.

Most often the disease occurs equally often in men and in women after 30 years. Clinically it is manifested by shortness of breath, dry, barking, raspy, or "pipe" cough, asthma attacks. Sometimes coughing may be accompanied by dizziness or vomiting. Asthma attacks can lead to fainting, and dyspnea poorly relieved with bronchodilators.

If the tracheal stenosis (tracheoles) occurs in the antenatal period, then it can be:

· Compression, i.e., due to pressure on the trachea enlarged thyroid gland, mediastinal tumors, or congenital cysts;

· Occlusive, i.e. arising from the presence of any obstacles inside the trachea. This is possible in pathological development of cartilage, resulting in part of the trachea takes the form of a narrow tube without membranous wall.

Diagnosis of tracheal stenosis

Clinical manifestations are 3 stages of tracheal stenosis:

1. Compensated stenosis – most often symptoms are absent. The inner diameter of the trachea is 0.6 cm or more.

2. Subcompensated stenosis – its symptoms are shortness of breath, cough, cyanosis, wheezing, impaired pulmonary ventilation and hemodynamic disorder even at low physical activity. The inner diameter of the trachea in this case is 0.3-05 cm

3. Decompensated stenosis is characterized by infectious complications, respiratory failure and hemodynamic of the patient in a calm state. The inner diameter of the trachea is equal to only 0.3 cm or less.

Tracheal stenosis in patients with head usually is tilted forward, the larynx is stationary (even with increased breathing), the voice is not changing or is changing a bit.

In the diagnosis of tracheal stenosis is mainly used endoscopic and radiographicresearch. The degree of patency of the trachea is determined by the testimony of pneumotachography. Often shortness of breath and coughing experienced by the patient associated with lung disease, due to which in many cases, tracheal stenosis is diagnosed in the later period.

Treatment scar and expiratory stenosis of the trachea

Treatment of corrosive strictures comprises endoscopic (through a scope) and open surgical intervention is undertaken for the expansion and restoration of the lumen of the trachea. Endoscopy removed scar tissue and through the narrowed area of the trachea is conical or cylindrical dilator (expander). A stable positive effect after this treatment observed in the majority of patients with tracheal stenosis. At relapse of disease to the patient in the long term are introduced in a prosthesis or being open surgery.

For the treatment of expiratory stenosis of the trachea is used endoscopy, and conservative treatment. To facilitate the condition of patients, reduce coughing and make breathing easier they recommend not tablets (they are inefficient), and the exercise of slow exhalation with artificial resistance. Exhale is produced with closed lips or through a narrow tube. In the early stages of expiratory stenosis is often possible to eliminate the expense of intensive treatment of bronchitis.

A new treatment of expiratory stenosis of the trachea and main bronchi can be called introduction to retrotracheal space sclerosing mixture. This operation is performed when performing bronchoscopy under local anesthesia or under General anesthesia. Stable positive effect was achieved in most cases, the primary expiratory stenosis and in half of the cases of secondary stenosis. Open surgical intervention with expiratory stenosis of the trachea is rare.