carbon dioxide laser treatment of tracheal stenosis

Precautions for carbon dioxide laser treatment of tracheal stenosis:

1. If possible, remove the scar tissue from the stenosis of the laryngotracheal tube as much as possible and enlarge the ventilation area until the laryngotracheal structure at the upper and lower ends is normal.

2. Surgery should be performed in the respiratory tract to avoid damage to tissues other than the laryngotracheal tube. Especially in the removal of scar tissue below the posterior region of the ankle joint, care should be taken to avoid damage to the tracheal membrane and cause tracheoesophageal fistula.

3. When the lower edge of the scar is removed, the anesthesiologist should be informed of the damage to the tracheal tube sleeve. At the same time, attention should be paid to protecting the tracheal cuff to avoid deflagration of the trachea.

Indications for carbon dioxide laser treatment:

1. Glottic region stenosis 0.5~1cm 2 stenosis length ≤3cm 3 Throat cartilage stent complete 4 clear non-malignant tumor lesions, including neck closed injury, improper long-term intubation, chemical laryngotracheal tube caused by laryngotracheal stenosis Burns, recurrent polybronchitis and nasal sclerosing diseases. SE, Wegenerl granulomatosis 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. The procedure uses a carbon dioxide laser to directly vaporize the scar that accumulates in the stenosis of the laryngotracheal tube at a narrow point exposed by a laryngoscope or other endoscope. Granulation tissue, precise cutting and hemostasis, to achieve the purpose of recanalization of the throat. The entire operation does not require opening the throat, the operation is relatively fine, the amount of surgery is small, and the T-shaped tube can be placed into the throat according to the situation. For the posterior glottic stenosis, carbon dioxide laser cutting is used to form the laryngeal mucosa microlobes, and the rotating flap covers the exposed wall to reduce granulation and promote healing.

At the same time, since the carbon dioxide laser energy is easily absorbed by water, the heat radiation to the laryngeal mucosa is small, and it is not easy to damage deep tissues; the carbon dioxide laser can delay the formation and maturation of collagen fibers, and is beneficial for pre- and post-surgical epithelialization of scar formation. Tissue reaction. Slight, not easy to cause laryngeal edema, it is not easy to form new scars and adhesions after surgery.

Limitations of carbon dioxide laser treatment:

1. High anesthesia requirements

Because it is operated in the airway, the airway management requirements for anesthesia are high, and each hospital is not equipped with high-frequency ventilation equipment. It is very important to communicate with an anesthesiologist during the procedure. Stenosis, can not be intubated, can be negotiated with the anesthesiologist before tracheotomy, and then anesthesia. The tube can be inserted directly into the tracheostomy port. If a short-term extubation is required during surgery, high-frequency ventilation can be used to maintain oxygen saturation and to achieve therapeutic goals through surgery.

2. There is a dead angle in the operation, and attention should be paid to the treatment of deep tracheal stenosis in the larynx.

Due to the small diameter of the tracheal tube, the fixed curvature, the small surgical space, and the large dead angle of surgery, some patients may not be adequately 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.