Congenital disease of the trachea

Introduction to tracheal congenital diseases Tracheal congenital disease is obstructive dyspnea that occurs after birth. It can cause wheezing during inhalation, difficulty in feeding, delay in growth and development, and severe supracondylar clavicle, intercostal soft tissue and sword. In the soft tissue depression, the above symptoms are aggravated when the respiratory tract infection occurs. X-ray tracheal tomography and endoscopy can confirm the diagnosis, and bronchography has the risk of aggravating obstruction. basic knowledge The proportion of illness: the incidence rate is about 0.0002%-0.0003% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumothorax

Causes of tracheal congenital diseases

Causes:

Embryology The esophagus and respiratory tract originate from the foregut of the embryonic gut in the process of occurrence. The original esophagus is located behind the respiratory organ. The gut is divided into three parts: the foregut, the midgut and the hindgut. In the early stage, the cephalic and caudal sides of the gut are locked. On the third week of embryogenesis, the pharyngeal rupture of the ventral side of the genital intestine ruptures, allowing the foregut to communicate with the ventral fossa. As the heart shifts downward, the length of the esophagus is rapidly Increase, on the 21st to 26th day of embryogenesis, the laryngotracheal groove appears on both sides of the foregut, and then the epithelium grows to form the esophageal tracheal septum, separating the esophagus from the trachea. If the esophagus and the trachea are not completely separated, the lumens of the two are connected. Esophageal obstruction is formed by the formation of esophageal tracheal fistula, esophageal tracheal septum deviation or excessive growth of the foregut epithelium to the esophageal lumen. In addition, in the early stage of esophageal development, part of the foregut cells are separated from the esophagus and continue to grow, which can form esophageal repetitive malformations, most of which are cysts close to the esophageal wall, and some cysts communicate with the esophageal lumen.

Tracheal congenital disease prevention

This disease is a group of congenital diseases, so there is no effective preventive measures. Strict care should be taken during the operation to prevent unnecessary harm to the children. For example, infants with small tracheal cavity and postoperative mucosal edema may cause Tracheal obstruction, the operative mortality is extremely high, and the anastomosis is still narrower than the normal part after growing up, so it is advisable to postpone the surgery as much as possible.

Tracheal congenital disease complications Complications

(1) Subcutaneous emphysema: It is the most common complication after operation, and it is separated from the soft tissue before the trachea. The short internal length of the tracheal incision or the suture of the skin incision is too tight. The gas escaping from the tracheal cannula can be along the incision. Enter the subcutaneous tissue space, spread along the subcutaneous tissue, emphysema can reach the head, chest and abdomen, but generally limited to the neck, most of them can be absorbed after a few days, no special treatment is needed.

(2) Pneumothorax and mediastinal emphysema: When the trachea is exposed, the downward separation is too much, too deep, and after the pleura is damaged, the pneumothorax can be caused, and the position of the right pleural apex is higher, especially for children, so the chance of injury is lower than that of the left side. More, lighter, no obvious symptoms, severe cases can cause asphyxia, such as the patient's tracheotomy, dyspnea relief or disappear, and soon after the emergence of breathing difficulties, you should consider pneumothorax, X-ray film can be diagnosed, this time should Pleural puncture, removal of gas, severe closed drainage, excessive separation of the anterior fascia of the trachea during surgery, gas along the anterior fascia of the trachea into the mediastinum, the formation of mediastinal emphysema, more mediation of the mediastinum, Separate down the sternum along the anterior wall of the trachea to allow air to escape upwards.

(3) Bleeding: a small amount of bleeding in the wound during surgery, can be stopped by pressure to stop bleeding or filled with gelatin sponge. If there is more bleeding, there may be vascular injury. The wound should be examined and the bleeding point should be ligated.

(4) Difficulty in extubation: If the site is too high during operation, the cartilage may be damaged, and the subglottic stenosis may be caused after surgery. The tracheal incision is too small. When the tracheal cannula is placed, the wall is pressed into the trachea; postoperative infection, Granulation tissue proliferation can cause tracheal stenosis, which is difficult to extrude. In addition, the inserted tracheal tube type is too large, and can not be successfully pulled out. Some patients with long tube length are afraid of breathing difficulties after extubation. When the tube is blocked, the patient may consciously breathe poorly. The small casing should be replaced gradually. Finally, if the tube is not difficult to breathe, the tube should be removed. For those who have difficulty in extubation, the cause should be carefully analyzed. X-ray film or CT examination should be performed. Mirror, bronchoscopy or fiber bronchoscopy, according to different reasons, as appropriate.

Tracheal congenital disease symptoms common symptoms, irritability, cough, neonatal laryngeal wheezing, three concave signs, dyspnea, difficulty feeding, esophageal fistula

This type of disease presents obstructive dyspnea with varying degrees of severity after birth. Wheezing can occur during inhalation, feeding difficulties, growth retardation, severe stenosis, insufflation of the supraclavicular fossa, intercostal soft tissue and xiphoid Soft tissue depression, the above symptoms are aggravated when respiratory infections occur, tracheal atresia, tracheal stenosis and tracheoesophageal fistula are more common, are described as follows:

(1) Tracheal atresia

After birth, it is often caused by tracheal intubation first aid, because the tracheal atresia, the endotracheal tube often passes through the laryngeal cleft to the esophagus, and then the junction of the esophagus and the distal trachea reaches the lungs. Although the patient breathed well, the X-ray showed that the endotracheal tube was inserted in the esophagus. When the repeated intubation was still the same, the disease should be suspected.

(2) tracheal-esophageal fistula

It can be divided into tracheal-esophageal fistula and bronchial-esophageal fistula. Although congenital anomalies can usually be found in newborns, the former type can be diagnosed until adolescents or even adults. Most cases have long-term feeding history or coughing. History, often cough out food particles, and occasionally combined with bronchiectasis.

(3) tracheal stenosis

Children with congenital tracheal stenosis, if the stenosis is not very serious, can show clinical symptoms in adolescence, including:

1. Shortness of breath, difficulty breathing, increased physical activity or increased secretions in the respiratory tract.

2. As the degree of stenosis increases, progressive breathing difficulties occur, and wheezing occurs during inhalation.

3. In the case of severe stenosis, the upper clavicle, the intercostal soft tissue, and the upper abdomen are simultaneously sunken (three concave signs).

Examination of tracheal congenital diseases

1, x-ray tracheal tomography can be found in the narrow trachea.

2, endoscopic examination can occur in the lesion.

3, tracheal lipiodol angiography examination is valuable for the diagnosis of tracheal stenosis and understanding of the scope of stenosis, but there is a risk of increased tracheal obstruction, it is worth noting, but in patients with tracheoesophageal fistula, lipiodol angiography can effectively show the fistula .

4, CT examination and swallowing examination can be used to check tracheal-esophageal fistula.

Diagnosis and diagnosis of tracheal congenital diseases

(1) Tracheal atresia or absence: This case is dead at birth, but the laryngeal and lung can develop normally, and sometimes the bronchus communicates with the esophagus.

(2) tracheoesophageal fistula : congenital esophageal atresia with esophageal tracheal fistula can be divided into 5 types:

Type I: The proximal and distal esophagus are closed, and there is no esophageal fistula.

Type II: The proximal end of the esophagus is connected to the trachea, and the distal end of the esophagus is blind.

Type III: The proximal end of the esophagus is blind, and the distal end is connected to the trachea.

Type IV: The proximal and distal esophagus are connected to the trachea.

Type V: The esophagus is not blocked, only the esophageal tracheal fistula.

The most common type III, about 85% to 93%, this case is type IV, relatively rare, the typical clinical manifestations of esophageal atresia are cough after feeding, and dyspnea and facial blemishes, children have saliva More, it can be seen that the foamed saliva overflows from the mouth and nostrils. When the esophageal atresia is suspected, the stomach tube is inserted through the nostrils or the oral cavity, and the normal children can smoothly enter the stomach, and the intubation of the esophageal atresia is blocked by about 8~12 cm. Or the catheter repeatedly turned out from the mouth, X-ray examination can confirm the diagnosis, the catheter can inject 1 ml of contrast agent to show the blind bag and its position in the upper part of the esophagus, the type IV is the upper end of the esophagus with iodine into the trachea, At the same time, the gastrointestinal gas is inflated, and the contrast agent can pass through the trachea into another mouth to the distal end of the esophagus.

(3) tracheal fistula: a thin layer of connective tissue diaphragm in the tracheal cavity, the central part of the diaphragm has a small hole for gas to pass, the tracheal fistula is often located under the annular cartilage, tracheal tomography and endoscopy to confirm the diagnosis, The diaphragm is removed by bronchoscopy. The diaphragm is long and thick. The tracheotomy is performed under the tracheal fistula, and the catheter is inserted. After the tumor is grown, the tracheal fistula is removed.

(4) Congenital tracheal stenosis: There is no abnormality in the development of the tracheal wall but the lumen is narrow. There are three types of stenosis: the scope and shape of the stenosis:

1 tracheal stenosis: the inner diameter of the annular cartilage is normal, the entire stenosis of the tracheal cavity below the annular cartilage, the most severe stenosis above the carina, sometimes only a few millimeters inside diameter, the main bronchus is normal,

2 tracheal funnel-shaped stenosis: can occur in the upper, middle or lower segment of the trachea, the length of the stenosis is different, the diameter of the trachea above the stenosis is normal, and the inner diameter of the stenosis is gradually narrow and funnel-shaped.

3 tracheal short stenosis: often occurs in the lower trachea, narrow length and length, may be associated with bronchial abnormalities, this type is most common.

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