RU2391929C1 - Method of treating trachea stenoses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine and can be used for treatment of trachea stenoses. Method includes bouginage and installation of stent. Bouginage of stenosis zone carried out by drawtube of rigid bronchoscope, after which stent is introduced into distal part of bronchoscope and intubation of trachea is performed. For this purpose distal part of drawtube of rigid bronchoscope with fixed in it stent is installed 1-2 cm lower than distal edge of stenosis zone, esophageal bougie with diametre corresponding to diametre of bronchoscope drawtube is introduced into drawtube. When bronchoscope is removed stent simultaneously is pushed into trachea lumen. Stent is made in form of intubation tube fragment, on whose surface located are perforated holes, and on tube ends longitudinal cuts from edge to middle of the tube 1.0 cm deep are made for formation of petals. Before stent installation bases of petals are heated and moved outwards.

EFFECT: application of claimed invention allows to fix stent reliably in trachea lumen for required time, and then remove it easily.

2 ex, 5 dwg

Description

The invention relates to medicine and can be used to treat stenosis of the trachea.

Violation of patency of the airways of varying severity during stenosis of the trachea with a cicatricial process leads to the development of obstructive respiratory failure. In its pathogenesis, a violation of the evacuation of bronchial secretion due to difficulty in coughing, a change in the rheological properties of the secret, its accumulation in the airways, which further violates the patency, are important. Under these conditions, infection of unevacuated sputum easily occurs and the effects of purulent tracheobronchitis join. The formation of tracheal stenosis takes place in several stages: acute - inflammatory narrowing, granulation; chronic - scar tissue degeneration. In the acute period, local treatment is carried out: anti-inflammatory, absorbable therapy, laser therapy, which can often prevent the process from becoming chronic. With existing cicatricial narrowing, as a rule, 6 months after the acute period, surgical treatment is possible. However, with almost any stenosis, treatment is doomed to failure without the use of endotracheal and endobronchial stents, which can stabilize the lumen of the respiratory tube and provide free breathing for a long time, including the stage of preoperative preparation (Shulutko AM, Ovchinnikov A.A. et al. Endoscopic thoracic surgery, Medicine, M., 2006, p. 74).

A known method of treating stenosis using a tracheal stent of Dumont (Shulutko A.M., Ovchinnikov A.A. Endoscopic thoracic surgery, M., Medicine, 2006, p. 78), which is a thin-walled silicone tube with spikes located on the outer surface.

However, the use of this prosthesis is not without drawbacks. Silicone is not a very durable material, which can lead to deformation of the stent in the lumen of the trachea; the presence of spikes leads to excessive pressure on the mucosa, thereby exacerbating the course of the pathological process; special guides are required to install the stent; when trying to shorten the product, sharp edges remain, which, in turn, are also a powerful traumatic agent.

Closest to the proposed method is a method for the treatment of tracheal stenosis, including pacing and installation of a smooth-walled stent, proposed by M.A. Rusakov in 1999 (Shulutko AM, Ovchinnikov A.A. Endoscopic thoracic surgery, M., Medicine, 2006, pp. .77). The stent used in the method is a piece of silicone tube, at the end of which a ligature is fixed, with which it is attached to the neck.

This model has drawbacks, these include: an unreliable position in the lumen of the trachea, the need for additional ligature fixation.

The objective of the invention is the creation of a simple and effective method for the treatment of tracheal stenosis at various stages of the disease due to the new design of the stent.

The proposed method for the treatment of stenosis of the trachea includes bougienage and stent placement. The stent is made in the form of a fragment of the endotracheal tube. Perforation holes are placed on its surface, and longitudinal cuts are made at the ends of the tube from the edge to the middle of the tube to a depth of 1.0 cm to form the petals, before installing the base of the petals, they are heated and removed outwards.

Perforations have a diameter of 0.5 cm and are located at a distance of 0.5 cm from each other.

At the ends of the tube, 6-8 cuts are made.

The base of the petals is heated to 70 ° C for 10 seconds.

Novelty of invention

- The stent is made in the form of a fragment of the endotracheal tube. The tube material has proven itself with prolonged use in relation to the trachea, hypoallergenic, has the necessary density, is easily removed with granulation tissue, which prevents further narrowing of the lumen of the trachea.

- Perforations are located on the surface of the tube. With the help of the holes, the stent is held in the lumen of the trachea, since the granulation tissue grows into the holes and thereby ensures the reliability of fixation.

- At the ends of the tube, longitudinal cuts were made from the edge to the middle of the tube to a depth of 1.0 cm to form the petals, before installing the base of the petals, they are heated and removed to the outside. The presence of the petals provides an increase in the diameter of the tube at the ends and a more reliable fixation. At the same time, the petals exert gentle pressure on the mucous membrane of the trachea.

- Perforations have a diameter of 0.5 cm and are located at a distance of 0.5 cm from each other. They are evenly distributed on the surface, a larger number of them can cause uncontrolled growth of granulation tissue, which is undesirable.

- At the ends of the tube make 6-8 cuts. A decrease in their number will lead to an increase in pressure on the mucous membrane, and an increase will lead to a decrease in pressure on the walls of the trachea, which can cause the prosthesis to migrate relative to the level of stenosis.

- The base of the petals is heated to 70 ° C for 10 s. These parameters do not cause destruction of the stent material and its fusion, but at the same time make the material ductile and allow it to be shaped.

Our proposed method allows you to securely fix the stent in the lumen of the trachea for the required time, and then easily remove it. The quality of treatment is improving.

The invention is illustrated by photographs and drawings shown in figures 1-5.

Figure 1 is a photograph of the proposed stent.

Figure 2 is a drawing of the stent.

Figure 3 - cicatricial stenosis of the trachea.

Figure 4 - stent in the lumen of the trachea.

Figure 5 is a view of the trachea after treatment.

Our proposed stent is a fragment of an endotracheal tube 1, for example, Murphy type, No. R61110085, perforation holes 2 with a diameter of 0.5 cm at a distance of 0.5 cm from each other are applied on its surface. From both ends, longitudinal cuts from the edge to the middle of the tube to a depth of 1.0 cm form the petals 3 (Fig. 1, Fig. 2). The base of the petals 3 is heated to 70 ° C for 10 s and taken out. With this technique, an increase in the diameter of the stent tube by 1/3 is achieved, while the mobility of the petals is preserved, which reduces the mucosal trauma.

The method is as follows. Before installing the stent, the stenosis of the stenosis area is performed by the tube of the rigid bronchoscope. After that, a stent, previously treated with hormonal ointment, is inserted into the distal part of the latter. Under the control of vision, tracheal intubation is performed. To do this, establish the distal edge of the tube of the rigid bronchoscope No. 13 with a stent fixed in it 1-2 cm below the distal edge of the stenosis zone, enter the esophageal bouge into the tube with a diameter corresponding to the diameter of the tube of the bronchoscope. Then, while removing the bronchoscope, the stent is simultaneously pushed into the lumen of the trachea. Due to the holes 2 and the petals 3, the stent is securely fixed in the trachea. Stent position is monitored using a fibrobronchoscope. A stent is removed using biopsy forceps with rigid or fibrobronchoscopy.

Example 1: Patient K., 62 years old. After the car accident, she was treated in the intensive care unit, where a long mechanical ventilation was performed. As a result of stabilization, she was transferred to the department of traumatology and then discharged for rehabilitation treatment. After 1 month, there was a deterioration in general condition, weakness, shortness of breath and stridor breathing. When fibrobronchoscopy: at the level of the 5th ring there was a circular narrowing of the lumen to 0.4 cm (figure 3). The cartilaginous relief of the trachea was deformed due to uneven mucosa, swelling, and massive overlays of fibrin. At 2.0 cm proximal to the carina, a second narrowing was determined, its shape was irregular, the clearance in this section was up to 0.7 cm. Tracheal bougienage was performed. A stent of the above construction with a length of 7.0 cm was installed in the lumen (Fig. 4). Over the next 3 weeks, control studies were performed (on average once every 4 days), which made it possible to assess the condition of the stent and bronchial tree, and to carry out rehabilitation. No stent migration detected. The patient was discharged home in satisfactory condition. After 2 months, the stent was removed. When FTBS: at the location of the stent, a cicatricial channel up to 0.9-1.0 cm in diameter was formed (Fig. 5), the cough reflex is satisfactory, the picture is sharp, in the center, there is a scarce mucous secret in the TBD. The mouths of the bronchi of the correct form are passable. Mucous pink. The patient’s breathing is free, the condition is satisfactory.

Example 2. Patient T., 22 years old. I was on a long mechanical ventilation for 2 weeks with a diagnosis of severe brain contusion. 2 months after discharge from the hospital with FTBS, cicatricial stenosis of the trachea was diagnosed at the level of the 2nd ring, with a length of 2 rings. The cartilaginous relief of the trachea is preserved. The mouths of the lobar and segmental bronchi are not changed, mobile. Spurs are sharp, pink mucous. The secret is scarce transparent. In a planned manner, the narrowing of the narrowing zone with a rigid rigid bronchoscope tube No. 13 was performed, in the stenosis zone, the stent 4 cm proposed by us was installed. Over the next 2 weeks, control studies were performed to assess the condition of the stent and bronchial tree, and sanations were carried out. No stent migration detected. The patient was discharged home. Control FTBS after 2 months. Stent removed. At the level of stenting, a fibrous channel is formed, the lumen is up to 1.3 cm. No more distant pathological changes have been identified. The patient's breathing is free, the condition is satisfactory.

Thus, the proposed method is simple, affordable and does not require a significant expenditure of time and material costs, the design of the stent ensures its reliable fixation, the quality of treatment improves.

Claims (4)

1. A method for the treatment of tracheal stenosis, including pacing and stent placement, characterized in that the stenosis area is staged with a rigid bronchoscope tube, then a stent is inserted into the distal part of the bronchoscope and the trachea is intubated, for this, the distal edge of the rigid bronchoscope tube is fixed with it fixed a stent 1-2 cm below the distal edge of the stenosis zone, an esophageal bouge is inserted into the tube with a diameter corresponding to the diameter of the tube of the bronchoscope, while removing the bronchoscope simultaneously push the stent into the lumen of the trachea, while the stent is made in the form of a fragment of the endotracheal tube, on the surface of which perforation holes are placed, and longitudinal sections are made at the ends of the tube from the edge to the middle of the tube to a depth of 1.0 cm to form the petals, before installing the stent, the base of the petals is heated and take out. 2. A method for treating tracheal stenosis according to claim 1, characterized in that the perforations have a diameter of 0.5 cm and are located at a distance of 0.5 cm from each other. 3. A method for the treatment of tracheal stenosis according to claim 1, characterized in that 6-8 sections are made at the ends of the tube. 4. A method of treating tracheal stenosis according to claim 1, characterized in that the base of the petals is heated to 70 ° C for 10 s.

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