RU2197184C2 - Method for restoring a scar-atretic larynx and a superior tracheal department - Google Patents

Abstract

FIELD: laryngosurgery, tracheal surgery. SUBSTANCE: laryngotracheofissure is carried out. Scars are dissected in the lumen of respiratory tract. A laryngotracheal prosthesis is placed there with a dilator as a hollow latex balloon filled with water. Beginning since the 6th-7th d after application of a laryngotracheal prosthesis one should withdraw for 7-8 sec and again introduce one third of water volume. Such a procedure should be repeated for 20 min twice daily till the end of epithelization of affected department of respiratory tract. EFFECT: accelerated process of epithelization. 2 dwg, 1 ex

Description

 The invention relates to medicine, namely to surgery of the larynx and trachea.

 An analogue of this invention is a hardware massage / Verbov A.F. Massage // BME. - M., 1960, - t.16, s.940-968 /, the essence of which is to massage the inaccessible organs of the body with the help of special devices and attachments attached to them, a direct mechanical effect on the organ is carried out.

 However, there is no such nozzle that would allow to massage the lumen of the larynx or trachea itself with their scar narrowing.

 The purpose of the invention is to accelerate the process of epithelization of the restored segment of the respiratory tract.

 To preserve the newly created lumen of the larynx and trachea during their cicatricial narrowing it is used by the laryngeal tracheal prostheses designed by V.A. Bystrenin and O.N. White / Bystenin V.A., O.N. White. "On the issue of laryngeal-tracheal prostheses", Bulletin of Otorhinolaryngology, 1981, 3, p. 81-84 /. The tubular part of the prosthesis is standard / cm. 1 / tracheostomy cannula 1, dilatator - a cylindrical latex filled with water 2. A thin metal tube 3 is soldered to the tracheostomy cannula, one end of which opens into the cavity of the latex balloon, the other end is connected to a rubber hose 4. The latter is closed by a clamp 5. Tubes 3, 4 serve to fill the balloon with water and release it from the water, which is done when the laryngeal tracheal prosthesis is removed and inserted into the larynx and trachea.

 The time during which the epithelization of the wound surface of the reconstructed segment of the respiratory tract when using a decommissioned prosthesis is completed is 6 months. The goal / acceleration of the epithelization process / is achieved by performing the procedure, which was called "hydromassage", during the period when the patients wear the laryngeal-tracheal prosthesis - this is a pulsating pressure change in the latex balloon-dilator of the prosthesis. "Hydromassage" improves blood supply to the wound surface, which accelerates its healing - epithelization. The procedure is carried out using a special apparatus, which is connected through a hose 4 to the dilatator cylinder and is automatically pumped out and again introduces 1/3 of the water filling the cylinder / cm for 7-8 s. FIG. 2 /. Such procedures are carried out for 20 minutes 2 times a day, starting from the 7th day after the operation.

 "Hydromassage" of the wound surface of the restored section of the respiratory tract was used in the treatment of 4 patients. The length of the inflated section of the respiratory tract / sublingual space of the larynx, the upper part of the trachea / in them was 2-2.5 cm.The epithelization of the wound surface of the respiratory tract in these patients was completed in 2-3.5 months, after which the laryngeal tracheal prosthesis was removed. The tracheostomy in 2 patients was sutured, in one patient it was closed independently. All three patients returned to normal breathing through the natural pathways. In the scientific medical and patent literature, methods that solve the problem in a similar way have not been identified. Based on this, we conclude that the distinguishing features of the proposed method meets the criteria of "novelty" and "significant castings".

Example
Patient P., 24 years old, was admitted to the City Clinical Hospital Emergency Medicine / City Clinical Emergency Hospital, Yekaterinburg / September 7, 1998 / medical history 13164 / with a diagnosis of cicatricial stenosis of the larynx, cannula carrier ".

 In May 1998, the patient received a stab wound to the neck with damage to the cartilage of the larynx, in connection with which he underwent surgery both to stop bleeding and to eliminate asphyxiation of the tracheostomy. However, later the patient could not be decanulated due to the development of cicatricial processes in the larynx with a narrowing of the lumen of the larynx to 3 mm and a length of 2 cm.

 September 8, 1998, the operation of the laryngofissure was performed. The aforementioned narrowing of the larynx, deformation of the left half of the thyroid cartilage was found. Scars were excised, the signet of the cricoid cartilage was dissected, and an arithenchordectomy was made on the left. A laryngeal-tracheal prosthesis / cm was placed in the lumen of the larynx and upper part of the trachea. FIG. 1/. Laryngotracheofissure in its upper part is sutured. From September 21, 1998, 2 times a day, for 20 minutes, a “hydromassage” of the wounded surface of the larynx was performed. 2 times a month, the laryngeal-tracheal prosthesis was removed and inserted back. At the same time, the bed of the restored part of the respiratory tract was examined, excess granulations growing on the wound surface were removed. 12/21/98, the complete epithelization of the restored section of the respiratory tract was ascertained. The laryngotracheal prosthesis is removed. 01/15/99, tracheostomy was sutured. 01.21.99, the patient was discharged home with satisfactory breathing.

Claims (1)

 A method of restoring the lumen of the larynx and upper part of the trachea during its cicatricial overgrowth, including performing laryngotracheofissure, excising scars in the lumen of the respiratory tract and placing a laryngeal tracheal prosthesis with a dilator in the form of a hollow latex balloon filled with water, characterized in that, starting from 6 On the 7th day after placing the laryngeal tracheal prosthesis from a latex balloon, 1/3 of the volume of water is pumped out and reintroduced for 7-8 seconds, repeating this procedure for 20 minutes daily, 2 times a day, until eniya epithelialization of the damaged sections of the respiratory tract.

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