Although there are many surgical treatments for laryngotracheal stenosis, such as traditional laryngeal splitting and catheter expansion, these traditional treatments take a long time, patients suffer more, and the incidence of re-stenosis is also very high. Therefore, the treatment of laryngotracheal stenosis has always been a clinical problem.
The recent successful treatment of several cases of laryngotracheal stenosis with carbon dioxide laser has provided new ideas for the treatment of this type of laryngotracheal stenosis.
The patient suffered from breathing after a trauma 1 year ago. A tracheotomy was performed in our hospital 10 months ago. A cervical laryngeal stenosis was found by electronic laryngoscopy 2 months ago. 20 days ago, the patient again had difficulty breathing and increased the weight for 3 days. Neck tracheal stenosis can be seen on X-ray examination.
Comparison of the Lumenis 40c CO2 laser treatment instrument before and after treatment of tracheal stenosis.
Domestic studies have also shown that carbon dioxide laser treatment of tracheal stenosis can significantly improve patient symptoms.
Points to note in the treatment of tracheal stenosis with carbon dioxide laser:
1 If possible, remove the scar tissue from the stenosis of the laryngotracheal tube as much as possible, and widen the ventilation area until the normal laryngotracheal structure at the upper and lower ends is revealed.
2 operation should be guaranteed to operate in the respiratory tract to avoid damage to tissues other than the laryngotracheal tube. In particular, when removing scar tissue below the posterior region of the ankle, care should be taken to avoid damage to the tracheal membrane and cause tracheal esophageal spasm.
3 When the lower edge of the scar is removed, the anesthesiologist should be informed whether the tracheal tube cuff is damaged. At the same time, the operation should pay attention to protect the tracheal tube cuff to avoid deflagration of the tracheal tube.
Indications for carbon dioxide laser treatment:
1 stenosis from the glottic area 0.5 ~ 1 cm 2 stenosis length ≤ 3 cm 3 laryngeal cartilage stent is completely intact 4 clear non-malignant neoplastic lesions, may include closed neck trauma, long-term improper intubation, chemical laryngeal tracheal burns Caused by laryngotracheal stenosis and recurrent polychondritis and nasal sclerosing disease, Wegenerl granuloma and other airway granulomatous lesions.
The advantages of carbon dioxide laser treatment of tracheal stenosis:
In the past 20 years, lasers have been used to gasify scar tissue in the laryngotracheal tube. This procedure uses a carbon dioxide laser to directly vaporize scars that proliferate in the stenosis of the laryngotracheal tube with support from a laryngoscope or other endoscopically exposed stenosis. Granulation tissue, precise cutting and hemostasis, to achieve the purpose of recanalization of the larynx lumen. The entire operation does not need to open the throat, so the operation is relatively fine, the operation is small, and the T-shaped tube can be placed in the laryngotus according to the condition. For the stenosis of the posterior glottic commissure, the carbon dioxide laser cutting is used to form the laryngeal mucosa microlobes, and the exposed wall is covered by the rotating flap to reduce the formation of granulation and promote healing.
At the same time, because the energy of carbon dioxide laser is easily absorbed by water, the thermal radiation to the laryngeal mucosa is small, which is not easy to cause damage to deep tissues; carbon dioxide laser can delay the formation and maturity of collagen fibers, which is beneficial to epithelialization before scar formation and postoperative tissue reaction. Slight, not easy to cause laryngeal edema, it is not easy to form new scars and adhesions after surgery.
Limitations of CO2 laser treatment:
1 high anesthesia requirements
Because it is operated in the airway, the airway management requirements for anesthesia are high, and high-frequency ventilation equipment is not equipped in every hospital. It is very important to communicate with the anesthesiologist during the operation. The stenosis, can not be intubated, can be negotiated with the anesthesiologist before tracheotomy, and then anesthesia. The tube can be directly inserted into the tracheostomy port. If a short extubation is required during surgery, high-frequency ventilation can be used to maintain oxygen saturation, and surgery is performed to achieve therapeutic goals.
2 operation has a dead angle, care should be taken to treat deep laryngotracheal stenosis
Because the tracheal tube has a small diameter and a fixed curvature, resulting in a small operating space and an operational dead angle, some patients may not be fully treated. At the same time, the treatment of deep laryngotracheal stenosis should be cautious, and T-tube implantation or laryngeal rupture should be performed as soon as possible when the curative effect is poor.
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