thyroid cartilage tracheal anastomosis

Treatment of diseases: laryngotracheal scar stenosis congenital subglottic stenosis Indication The thyroid cartilage tracheal anastomosis is suitable for: 1. Scarring under the glottis. 2. Acute laryngotracheal rupture. Contraindications 1. The stenosis length is more than 5cm. 2. Ring cartilage posterior plate defect. 3. Children under the age of 15. 4. Cervical arthritis and limited neck activity. 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 scar stenosis, injury site, extent, extent and cartilage defects in the laryngotracheal tube. 3. Take the X-ray or CT scan of the lateral position of the larynx to understand the location of the scar, the location, extent, extent and cartilage defects. 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, and surgery may be necessary. Surgical procedure 1. Incision and separation of the anterior cervical tissue are divided into straight incisions and U-shaped incisions: (1) Straight incision: In the middle of the neck, the lower edge of the hyoid bone is raised, and the upper sternal notch is 1 to 2 cm. The skin, subcutaneous tissue and platysma are vertically cut, and the skin is separated to both sides. (2) U-shaped incision: 2 cm from the upper sternal notch to make a U-shaped incision, both sides to the inner edge of the sternocleidomastoid, thyroid cartilage plane, incision of the skin, subcutaneous tissue to the platysma, from the platysma Separate the hyoid bone, cover the platysma with a sterile cotton pad, suture a few needles outside, and then attach it to the hyoid bone with the platysma. 2. After cutting off the thyroid isthmus and incision of the anterior cervical tissue of the thyroid cartilage, the thyroid isthmus is covered on the anterior wall of the second and third tracheal rings, and the thyroid isthmus is freed from the anterior wall of the trachea by vascular clamp. Take two vascular clamps to clamp the isthmus, cut the isthmus in the middle, suture it with silk thread, separate the isthmus to the sides, and expose the 2nd and 3rd tracheal rings. The ring-shaped nail membrane is cut transversely. If there is bilateral vocal cord paralysis, the thyroid cartilage plate is cut along the thyroid cartilage, and one side of the sacral cartilage is removed from the mucosa, and the vocal cords are abducted and fixed. 3, resection of scar stenosis from the 2nd and 3rd tracheal ring fascia incision, lift the second tracheal ring, carefully separate the adhesion between the narrow area of the scar and the surrounding tissue. When separating the posterior wall, be careful not to damage the anterior wall of the esophagus, and remove the scars of the first and second tracheal rings of the scar and the anterior wall of the cartilage, and retain the posterior plate of the cartilage. You can see that there is a left between the thyroid cartilage and the third tracheal ring. 3cm wide crack. 4, free trachea lift the end of the trachea, with fingers or vascular clamps to bluntly separate the trachea and surrounding tissue, until the sternum, so that the trachea is completely free. Care should be taken to protect the paratracheal vessels on both sides when separating the paratracheal tissue. If the recurrent laryngeal nerve is not damaged, the recurrent laryngeal nerve should be carefully separated from the scar tissue on both sides to avoid damage. 5. Separate thyroid cartilage from the upper edge of thyroid cartilage to cut the thyroid gland muscle and the upper thyroid cartilage. A transverse incision is made from the middle of the thyroplasty to the anterior epiglottis, and the anterior epiglottic space is separated to lower the thyroid cartilage, and the tracheal stump is lifted upward until the thyroid cartilage and the tracheal ring can be closed. 6, thyroid cartilage and tracheal anastomosis with 3-0 gut first suture the posterior tracheal wall and annular cartilage plate. Then the trachea and thyroid cartilage are sutured from the posterior to the front with a 3-0 gut. Each suture should pass under the tracheal cartilage ring mucosa, do not penetrate the mucosa, the suture is completely worn, and then the tissue clamp will be used. After the trachea and the thyroid cartilage are pulled together, the sutures are ligated one by one. The ligature is outside the trachea. 7. The suture incision was sutured with 3-0 gut sutures on both sides of the thyroid cartilage membrane and the anterior cervical band muscle. The wound was washed with saline, the flow strip was placed, and the subcutaneous tissue and skin were sutured with fine silk thread. The incision is wrapped with a sterile dressing. The sacral skin and the anterior cervical skin are sutured with a thick thread to fix the head in the forward tilt position, reducing the tension of the thyroid cartilage and the tracheal anastomosis. 8. Pull out the anesthesia cannula and place the tracheal cannula. complication Incision bleeding Repeated blood was taken out after the operation, indicating that there was bleeding in the incision in the larynx. The incision should be opened to find the bleeding point to stop bleeding. 2. Subcutaneous emphysema Subcutaneous emphysema can occur if the incision is not tightly sutured, the respiratory tract is not smooth, or the cough is severe after surgery. In the case of subcutaneous emphysema, it is advisable to remove the suture of the neck skin and make the respiratory tract unobstructed and give antitussives. 3. Laryngeal tracheal restenosis The larvae can sometimes be grown at the suture opening of the laryngotracheal tube. If granulation is found, it can be bitten with a bite.