Stenosis of a trachea and bronchial tubes
Stenosis of a trachea and bronchial tubes – narrowing of pneumatic ways as a result of morphological changes of their wall or external sdavleniye. Trakheo-and bronkhostenoza are shown by respiratory frustration: short wind, cough, stridorozny type of breath, cyanosis, involvement of auxiliary muscles in the act of breath. The diagnosis is specified by means of beam (a X-ray analysis, a tomography, a bronchography), endoscopic (trakheobronkhoskopiya) and functional techniques (spirometry). Treatment of functionally significant stenoses of a trachea and bronchial tubes endoscopic (a buzhirovaniye, endoprosthesis replacement, dilatation) or quick (a resection of the changed site of a trakheobronkhialny tree or a lung, etc.).
Stenosis of a trachea and bronchial tubes
Stenosis of a trachea and bronchial tubes - violation of trakheobronkhialny conductivity which cornerstone organic or functional defects of pneumatic ways are. Stenoses can have the congenital and acquired origin. True frequency of narrowings of a gleam of a trakheobronkhialny tree of organic genesis is unknown, functional stenoses according to various data make 0,39-21% of total of cases of pathology. Stenoses of a trachea and large bronchial tubes cause frustration of the act of breath, frequent infectious complications also can even lead to a lethal outcome from asphyxia. In this regard in pulmonology search and improvement of radical methods of treatment of stenoses, including with use of methods of endoscopic surgery does not stop.
Classification of a stenosis of a trachea and bronchial tubes
Except the congenital and acquired origin, stenoses of a trachea and bronchial tubes can have the organic, functional or mixed nature. In turn, organic stenoses can be primary (the caused morphological defects of a trakheobronkhialny wall) and secondary, or compression (caused by a sdavleniye of pneumatic ways outside).
On the extent of the narrowed site allocate limited (up to 2 cm) and an extended stenosis (more than 2 cm); taking into account an etiology – idiopathic, posttrakheostomichesky, postintubatsionny, post-traumatic, etc. Depending on reduction of diameter of a gleam the acquired organic primary stenoses of a trachea and the main bronchial tubes can have three degrees:
1 - the gleam is reduced by a third of diameter
2 - the gleam is reduced by two thirds of diameter
3 - the gleam is reduced more than by two thirds of diameter
On expressiveness of clinical manifestations distinguish a stenosis in a stage of compensation, subcompensation and decompensation. The compensated stenosis of a trachea proceeds with the minimum symptoms; at the subcompensated form of violation of breath arise at insignificant physical activities; sharp respiratory frustration at rest are characteristic of a dekompensirovanny stenosis.
The functional (expiratory) stenosis of a trachea and the main bronchial tubes (trakheobronkhialny hypotonia / dyskinesia, expiratory collapse of a trachea and large bronchial tubes) arises as a result of the congenital or arisen later birth of thinning of a membranozny part of large pneumatic ways. Congenital stenoses of a trachea meet extremely seldom.
Reasons of a stenosis of a trachea and bronchial tubes
As the reason of primary acquired stenoses most often serve cicatricial narrowings of a trachea and bronchial tubes. Cicatricial deformations of a trakheobronkhialny wall can develop after a long intubation and IVL, a trakheostomiya, trachea and bronchial tubes operations, damages (burns of airways, traumatic gaps), long finding of foreign matters in bronchial tubes. In some cases the stenosis turns out to be consequence of nonspecific inflammatory processes or tuberculosis. Can lead an external sdavleniye of air-conducting ways to a compression stenosis the increased lymph nodes at tubercular lymphadenitis, sredosteniye tumors, a bronkhogenny cyst.
Primary congenital stenosis is caused by anomaly of development of a trakheobronkhialny wall at which the hypoplasia of a membranozny part of a trachea and a partial or full smykaniye of cartilaginous rings takes place. The majority of cases of a vtoyorichny congenital stenosis is connected with a double arch of an aorta which squeezes chest department of a trachea, or embryonic cysts and tumors of a sredosteniye.
The functional congenital stenosis is caused by a prolapse of a membranozny part of a trachea and the main bronchial tubes owing to a system dysplasia of connecting fabric. At children it is quite often combined with anomalies of a bite, deformations of a backbone, flat-footedness, hyper mobility of joints, "the Gothic sky", a miopiya and an astigmatism, hernias of a stomach and other phenotypical markers of weakness of connecting fabric.
Symptoms of a stenosis of a trachea and bronchial tubes
Weight of manifestations is caused by a number of factors: stenosis degree, its etiology, extent of compensation. Usually bright clinical symptomatology arises when narrowing diameter of tracheas/bronchial tubes for 50% and more. In all cases the stenosis of a trachea and bronchial tubes is shown by disorders of respiratory function, hypoventilation or emphysema of lungs, development of inflammatory changes (tracheitis, bronchitis) places of narrowing are lower.
The complicated noisy exhalation - an expiratory stridor is the most typical sign of a stenosis of a trachea. At heavy disorders of breath of the patient holds the compelled position with a ducking forward; auxiliary muscles are involved in breath; short wind, cyanosis is noted. Congenital stenoses of a trachea have an effect at once after the birth or in the first days of life. When feeding children with a stenosis of a trachea the poperkhivaniye is noted, often there is causeless cough, attacks of cyanosis or suffocation. Further lag in physical development is traced. In hard cases death of the child can occur on the first year of life from the joined pnevmoyoniya or asphyxia.
The clinic of a functional stenosis of a trachea is characterized by a kashlevo-unconscious syndrome. In the beginning the patient has a dry barking cough which can be provoked by change of a pose (inclinations, turns, laughter, shout, a natuzhivaniye and other actions). At height of a kashlevy attack there is suffocation, dizziness, consciousness loss, . Duration of a faint can fluctuate from 0,5 to 5 minutes. Restoration of breath happens through a stridor stage. After an attack the otkhozhdeniye of a viscous lump of a mucous phlegm, motive excitement is noted.
Stenoses of large bronchial tubes are followed by cough, as a rule, painful, pristupoobrazny which often mistakenly suggests an idea of bronchial asthma. The recurrent bronchitis and pneumonia caused by violation of drainage function of a bronchial tree are characteristic of stenoses of this localization. During the periods of an aggravation of inflammatory process deterioration in health, temperature increase, cough with a purulent phlegm, emergence of stridorozny breath is noted.
Diagnostics of a stenosis of a trachea and bronchial tubes
The clinic of a stenosis of a trachea and bronchial tubes is typical for many diseases of a trakheobronkhialny tree. Therefore when performing diagnostics pulmonologists lean, mainly, on objective methods of a research: radiological, endoscopic, functional.
The first step on the way of diagnosis is the X-ray analysis and a tomography of a trachea and lungs. Are radiological signs of reduction of a gleam of airways a shape of a trachea in the form of hourglasses, an immovability of its membranozny wall, expansion of a gleam is lower than the place of narrowing, or emphysema of the relevant department of a lung Data on localization, extents and degrees of a stenosis are specified by means of contrast researches - trakheografiya and bronchographies. In detection of the vascular anomalies appealing a trachea stenosis the aortografiya role is big.
Crucial importance in diagnostics of a stenosis of a trachea and bronchial tubes belongs to endoscopy of airways – trakheoskopiya, bronkhoskopiya in the course of which there is an opportunity visually to confirm morphological changes of a trakheobronkhialny wall, to specify a stenosis etiology by means of a biopsy (cicatricial, tumoral, tubercular). At patients with organic stenoses of a trachea and bronchial tubes research FVD (spirometry, a pnevmotakhografiya) is of secondary importance (obstructive violations come to light), however these methods are widely used for confirmation of an expiratory stenosis.
Treatment of a stenosis of a trachea and bronchial tubes
At stenoses of an organic origin treatment, as a rule, quick. Preference is given to endoprosvetny manipulations if those are technically feasible. So, at cicatricial stenoses of a trachea injections of Prednisolonum or a triamtsinolon in cicatricial fabric or its laser vaporization, endoscopic restoration of a gleam by means of bronchoscopic tubes, a buzhirovaniye, balloon dilatation, endoprosthesis replacement of the stenozirovanny site stenty can be made.
In case of inefficiency or impossibility of performing endoscopic treatment the circular resection of the site of a stenosis with the subsequent imposing of an anastomoz "the end in the end" is carried out. If according to inspection bronkhoektaza come to light, or other irreversible changes of bronchial tubes, the resection of a lung or a pnevmonektomiya is made. Treatment of a compression stenosis of a trachea consists cysts, tumors of a sredosteniye which caused narrowing at a distance. At extensive subtotal stenoses of a trachea only transplantation of body is possible.
At stenoses of a trachea of functional character conservative and waiting tactics can be applied, however it has palliative, symptomatic character. During aggravations protivokashlevy means (, codeine), mucolytics (Bromhexine, ), NPVS, antioxidants (vitamin E), immunomodulators are appointed. Carrying out medical bronkhoskopiya with introduction of antibiotics and proteolytic enzymes is effective. From non-drug means of therapy the acupuncture, a lazeropunktura, an electrophoresis, acupressure, breathing exercises is applied. Radical treatment of a prolapse of a membranozny part of a trachea or main bronchial tube assumes carrying out plastic reconstructive intervention (strengthening of a membranozny part autorebry or a fastsialny rag).
Forecast and prevention of a stenosis of a trachea and bronchial tubes
Results of expeditious treatment of a stenosis of a trachea and bronchial tubes mostly satisfactory. The lethality is minimum, attacks of suffocation and cough disappear right after operation. Conservative and waiting tactics can be justified only at the compensated forms of a stenosis or serious associated diseases. The Nekorrigiruyemy subcompensated and dekompensirovanny stenoses threaten with development of a full obturation of a gleam of a trakheobronkhialny tree and asphyxia.
The preventive direction provides the prevention of injuries of a trachea and bronchial tubes when carrying out vnutriprosvetny manipulations, injuries of pneumatic ways in the matter, timely treatment of nonspecific and specific processes, recognition and removal of foreign matters and tumors of a sredosteniye.