RU2409326C2 - Aperture of anterior wall of trachea - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, and may find application in surgery on trachea. Substance of method of aperture of anterior wall of trachea consists in cutting of all layers of wall with opening of trachea lumen in intertracheal gap. Cut is made in intercircular gap along medium line on trachea. Two transverse cuts are made on upper and lower ends of cut, and cut of cross-like shape is arranged in intercircular gap.

EFFECT: using this invention makes it possible to improve configuration of wound of anterior wall of trachea in case of tracheostomy, to reduce hazard of trachea anterior wall wound and cellular neck cavities suppuration.

2 ex, 1 dwg

Description

The method of the invention relates to medicine, and more specifically to methods of applying a tracheostomy, and allows to facilitate the technique of performing the operation and reduce complications in the postoperative period, can be used in surgery, traumatology, neurosurgery, otorhinolaryngology, anesthesiology, oncology, as well as in all patients requiring resuscitation care.

A known method of a transverse section of the anterior wall of the trachea in the annulus for applying a tracheostomy [1].

Its disadvantage is excessive trauma to the trachea and the risk of infection spreading to the cellular spaces of the neck.

A known method of a longitudinal section of the trachea with the intersection of one or more rings of the trachea [2].

The disadvantage of this method is that when performing an aperture of the anterior wall of the trachea, excessive trauma to the organ, violation of the tracheal framework, the risk of developing stenosis of the trachea after surgery occurs.

A known method of conducting prolonged mechanical ventilation through a tracheostomy cannula with a tracheostomy cuff in patients with combined trauma [3, 4].

Its disadvantage is the impossibility of sanitizing the pretracheostomy space and the formation of cicatricial stricture of the trachea.

The aim of the method of the invention is to improve the configuration of the wounds of the anterior wall of the trachea when performing a tracheostomy, reduce the risk of suppuration of the wounds of the anterior wall of the trachea and cellular spaces of the neck, ease of use and shorten the treatment time.

формы, разрез пересекает не менее одного кольца трахеи.This goal is achieved by the fact that along the midline on the trachea, the incision in the inter annulus and on its upper and lower ends contains two additional transverse incisions; the incision made in the intercircular space is made in the form of a cross

forms, the incision crosses at least one tracheal ring.

Comparison of the invention with other known apertures has shown that its criteria are consistent with the method of the invention.

The method of the invention is illustrated in the drawing, which shows the configuration of the incision of the anterior wall of the trachea and the type of operation.

The method of the invention is used as follows.

формы. Вместо поперечного разреза 6 при необходимости выполняют два других поперечных разреза - один 7 в вышележащем 3 межкольцевом промежутке, а второй 8 в нижележащем 5 межкольцевом промежутке. В образовавшуюся апертуру крестообразной формы на передней стенке трахеи вставляют расширитель трахеи. В трахею вводят трахеостомическую трубку в зависимости от возраста больного и величины просвета трахеи, рану на шее зашивают до трахеостомической канюли и через трахеостомическую канюлю проводят искусственную вентиляцию легких. Способ наложения трахеостомы применен у 168 больных. Осложнений, связанных с применением описанного изобретения, не было.A longitudinal section of the skin, subcutaneous tissue, superficial (second) fascia of the neck, pretracheal muscles, pretracheal (fourth) fascia of the neck is made along the midline of the neck above the jugular notch, and the front wall of the trachea is exposed. With a single-tooth hook, the overlying ring of the trachea 1 is raised upward on the front wall of the trachea (A), along the midline on the front wall of the trachea, a longitudinal incision is made 2 of the inter-ring gap of the trachea 3, of one of the underlying ring of the trachea 4, together with the underlying inter-ring gap 5. Then, the overlying inter-ring gap is dissected. 3 in the transverse direction 6 so that a cruciform aperture is formed on the front wall of the trachea (A)

forms. Instead of the transverse section 6, if necessary, two other transverse sections are performed - one 7 in the overlying 3 inter-ring gap, and the second 8 in the underlying 5 inter-ring gap. A trachea dilator is inserted into the formed cross-shaped aperture on the front wall of the trachea. A tracheostomy tube is inserted into the trachea depending on the age of the patient and the size of the tracheal lumen, the wound on the neck is sutured to the tracheostomy cannula, and mechanical ventilation is performed through the tracheostomy cannula. The tracheostomy application method was applied in 168 patients. There were no complications associated with the use of the described invention.

Clinical example 1. Patient Z., 24 years old and / b 21431, 08/02/07 after an automobile injury, was hospitalized as an emergency in the Department of Neurosurgery of Moscow State Medical University named after N.I. Pirogova No. 1, Samara, with a diagnosis of concomitant injury, severe head injury, chest injury, bilateral hemopneumothorax, multiple floating fractures of the ribs on the left, a fracture of the femur on the left. By Bulau drainage of the pleural cavities, skeletal traction behind the ribs on the left, and osteosynthesis of the femur were performed. A tracheostomy was applied according to the described method, a tracheostomy cannula No. 9 was used, there were no complications associated with a tracheostomy.

Clinical example 2. Patient J., 32 years old and / b 30762 after a car accident on 10/22/2008 was hospitalized at MMU "City Clinical Hospital named after N.I. Pirogova No. 1 Samara with a diagnosis of concomitant chest injury, lung contusion, heart contusion, multiple floating fractures of the ribs on the left, hemopneumothorax on the left. 10/28/2008, a tracheostomy was applied according to the described method. The patient underwent a course of treatment, skeletal traction of the chest by the ribs, was de-canned on November 5, 2008, there were no complications associated with tracheostomy. The condition improved on 11/11/2008. Discharged for outpatient treatment.

Using the proposed aperture allows to improve the treatment results of 168 patients with impaired external respiration function and reduce complications due to the expansion of the formed wound on the front wall of the trachea, the intersection of only one tracheal ring. There were no complications associated with the use of the aperture. The method of applying a tracheostomy has shown its effectiveness, reliability and can be widely used in clinical practice in the treatment of patients with impaired respiratory function.

Information sources

1. Kovanov V.V. Operative surgery and topographic anatomy. M .: Medicine, 1978. - S.299-300.

2. Perelman M.I. Trachea surgery. M .: Medicine. - 1972, - p. 120-128.

3. Sokolov V.A. Multiple and associated injuries. - M.: GEOTAR - Media, 2006, - p.264.

4. Popova L.M. Neuroresuscitation. M .: Medicine. - 1983, - p.239-243.

Claims (2)

1. An aperture of the anterior wall of the trachea, containing an incision of all layers of the tracheal wall with the opening of its lumen in the intertracheal gap, characterized in that a midline on the trachea performs an incision in the interring space and at its upper and lower ends there are two additional transverse sections, and the inter-ring gap contains a cross-shaped incision. 2. The aperture of the anterior wall of the trachea according to claim 1, characterized in that the incision crosses at least one ring of the trachea.

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