T型支架的应用.pptVIP

Tracheal Stenosis T-tube usage Part I : Case Report Case I : Brief History 57 y/o female H/T; CVA(91/3) s/p tracheotomy in 博仁H. Subglottic stenosis(2cm below glottic level)in 亞東H. by rigid bronchoscopy Laryngotracheoplasty and T-tube insertion on 92-3-27 Remove the T-tube on 92-10-02 Case I : Procedures ETGA (paralyzed by SCC, then pass a 5.0# ETT from the mouth through the T-tube) Stomaplasty: excision of the granulation tissue around the stoma Pull out the ETT and remove the T-tube, then inserted the ETT from the stoma into trachea Laryngotracheoplasty: excision of the subglottic granulation tissue by rigid bronchoscopy Remove the ETT when the P’t awaked Case II : Brief History 44 y/o male Pulmonary TB s/p left side pneumonectomy 23 yrs ago (with previous tracheotomy scar) Dyspnea on exertion from 5yrs ago, progressed recently. Bronchoscopy at OPD revealed severe subglottic tracheal stenosis 5cm below vocal cord, then confirmed by CT. 92/3/25 T-tube insertion (by ENT), then discharged on 3/28 92/10/06 T-tube exchange was planned (by Chest) Case II : Procedures ETGA: Induction as usual, but failed to pass by the 7.0# ETT through the T-tube Desaturation!! Mask ventilation but hardly, then change to ventilate the p’t through the T-tube by a ETT connector→successfully ventilated. Exchange the T-tube to low-pressure tracheotomy Intubated again with 6.0# ETT ,passed through successfully after withdraw the low-pressure tube Excision of the granulation tissue around the stoma, and changed a larger T-tube beneath the vocal cord carefully. Tracheal Stenosis T-tube usage Part II : Article Review Tracheal stenosis after long-term endotracheal intubation or tracheostomy Incidence: ~31% Site: Cuff level or stoma level Degree of stenosis: 11~25% in 18% patients, 26~50% in 22% patients, and 50% in 3.7% patients (Walz et al ); but only 3~20% were symptomatic (stenosis30%) S/S: shortness of breath and either or both inspiratory stridor and expiratory wheeze on exertion ; unre