RU2325857C2 - Non-constrictive tracheostoma formation - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: invention can be used for removing traheostomy stenosis. The main point of the invention is trachea division and the traheostomy formation. Skin incision is performed with the formation of 4 grafts. Expose the trachea is exposed and revealed by X-shaped method between the 2^nd and 4^th semirings with the formation of 4 cartilage grafts. The central part of the lateral cartilage grafts is caught up to the bowing muscle medial legs. The free edges of the two sides and lower cartilage grafts are caught up to the flap. Upper cartilage graft is incised during the gorge extirpation, and after that the flat is caught up to its base. The use of this invention allows to achieve the voice creating thanks to the dissection of the lower detrusor pharynx muscles and preventing the obstetric fistula.

EFFECT: achieving of the voice creating thanks to the dissection of the lower detrusor pharynx muscles and preventing the obstetric fistula.

1 ex

Description

The invention relates to medicine, more specifically to surgery, and can be used if necessary to eliminate stenosis of the tracheostomy that arose due to the small diameter of the tracheostomy or as a result of suppuration and scarring of its lumen.

There is a known method of operation to increase the diameter of the tracheostomy due to an oblique incision of the trachea, as a result of which breathing normalizes (Kozlova A.V., Kalina V.O., Hamburg Yu.L. Tumors of ENT organs. M. - 1979).

However, when the trachea is dissected, a part of the trachea in the region of the cartilaginous semirings is thus excised, which weakens the tracheal frame and causes a narrowing of its lumen, which necessitates repeated surgical interventions and the obligatory wearing of the tracheotomy tube.

A known method of surgery on the trachea, in which the trachea is cut into two parts to a depth of two rings at the level of 3 and 9 hours of the conditional dial. Then two skin flaps are formed with the base outward, and the apex to the dissected edges of the trachea. The flaps are sutured into the dissected part of the trachea (Hilgers F.J., Balm A.S. Long-term results of vocal rehabilitation after total laryngectomy with the low-resistance underling Provax voice prothesis system. Clin. Ototlaryngolog. 1993, 18, 517-523).

However, with this method, the trachea loses stability, and due to the traction of the bronchi and lungs, the tracheostomy gradually lowers, involving surrounding skin and soft tissues. Over time, the lumen of the trachea becomes narrow, which necessitates repeated surgical interventions and the wearing of a tracheotomy tube.

The aim of the invention is the ability to maintain full breathing without a tracheotomy tube.

The goal is achieved by the fact that on the skin of the neck, in the projection of the tracheostomy, a curly skin incision is made with the formation of 4 flaps. The trachea is gradually exposed according to the known method, an X-shaped opening of the trachea between 2 and 4 half rings is carried out with the formation of 4 cartilaginous flaps. The central parts of the lateral flaps are sutured to the medial legs of the sternocleidomastoid muscle; the free edges of the two lateral and lower flaps are sutured to preformed skin flaps; the upper cartilaginous flap is excised during extirpation of the larynx, and the upper skin flap is sutured to its base. The operation is completed by the formation of a wide tracheostomy.

A comparative analysis of the proposed "Method of forming a non-stenotic tracheostomy" with known methods of surgical interventions on the trachea allows us to state that it is new and significantly different from those used.

The novelty of the proposed method lies in the fact that the implementation of the X-shaped section of the trachea between 2 and 4 half rings of the trachea with the formation of 4 triangular cartilaginous flaps and hemming of the middle of the lateral cartilaginous flaps to the medial legs of the sternocleidomast, and the lower cartilaginous flap to the skin can significantly expand and maintain the lumen of the trachea without the use of a tracheotomy tube.

In available open sources of information in Russia, the CIS countries and abroad similar to the claimed method is not found.

The developed "Method for the formation of a non-stenotic tracheostomy" is industrially applicable. It can be reproduced and repeated many times in medical institutions of a surgical profile and in specialized ENT clinics.

The method is as follows.

Under local anesthesia with a 0.5% solution of novocaine, the trachea is opened X-shaped between 2 and 4 half rings and 4 triangular cartilaginous flaps are formed. The central parts of the lateral flaps are sutured to the medial legs of the sternocleidomastoid muscle, and the free edges of the two lateral and lower cartilaginous flaps are sutured to the skin flaps. The upper cartilaginous flap is excised during extirpation of the larynx. Then form a wide tracheostomy.

An example of a specific implementation of the method can serve as an extract from the medical history.

Patient M., 63 years old, medical history No. 1021 / x, was admitted to the Department of Head and Neck Tumors, RNII on February 2, 2006, with a diagnosis of stage III larynx cancer (T3N0M0). Sick for 6 months. Upon receipt complained of hoarseness and pain when swallowing. When examining the larynx, an ulcerated tumor was found, occupying the base of the epiglottis with spreading to the right half of the larynx, causing its immobility and passing to the anterior parts of the left half of the larynx. At the first stage, it was decided to perform surgical intervention, and at the second - to conduct radiation therapy.

On February 7, 2006, the patient underwent a laryngectomy with the formation of a non-stenotic tracheostomy. Gist. an. No. 847829-30: moderately differentiated squamous cell carcinoma with a tendency to keratinization, ulceration, necrosis. Initially, under local anesthesia (sol. Novocaini 0.5%), the trachea was opened X-shaped between 2 and 4 half rings, with the formation of 4 triangular cartilaginous flaps. The central parts of the lateral flaps were hemmed to the medial legs of the sternocleidomastos, and the free edges of the two lateral and lower flaps were sewn to the skin flaps. The upper cartilage flap was excised. These interventions made it possible to widely open the lumen of the tracheostomy and fix the trachea, excluding its lowering. Then a typical extrusion of the larynx was carried out. The larynx is removed from the bottom up. Thus, a wide-lumen tracheostomy was formed that did not require the introduction of a tracheotomy tube. During the follow-up examination after 3 months (05/07/06) - no complaints, the tracheostomy is wide, providing free breathing.

Technical and economic efficiency of the developed method consists in the possibility of:

- achieve a wide tracheostomy that does not require the use of a tracheotomy tube;

- fix the trachea, excluding lowering down and narrowing its lumen;

- achieve a stable functional effect;

- reduce psychological discomfort and facilitate the social adaptation of the patient, his quality of life;

- preservation of the upper trachea, if necessary, subsequent tracheoesophageal bypass surgery.

Claims (1)

A method of forming a non-stenotic tracheostomy, including dissecting the trachea and forming a tracheostomy, characterized in that a skin incision is made with the formation of 4 flaps, the trachea is exposed, opened with an X-shaped method between 2 and 4 half rings with the formation of 4 cartilaginous flaps; the central parts of the lateral cartilaginous flaps are sutured to the medial legs of the sternocleidomastoid muscles; the free edges of the two lateral and lower cartilaginous flaps are sutured to the skin flaps; the upper cartilaginous flap is excised during extirpation of the larynx, and the upper skin flap is sutured to its base.