What Is Bronchoconstriction?

Trachea and bronchial stenosis are caused by shortness of breath and dyspnea caused by airway obstruction. Physical activity and respiratory secretions increase, and wheezing is common. In cases where tracheotomy and intubation have been performed, the above symptoms should be considered first. Anterior, lateral, and oblique tracheal tomography or cervical and chest CT can clearly show the location, extent, length, and morphological changes of the stenosis.

Basic Information

English name

tracheobronchial stenosis, stricture of trachea and bronchus

Visiting department

Respiratory Medicine

Common causes

After tracheotomy, benign or malignant tumors in the trachea and bronchus, inflammatory granulomas, and foreign bodies in the airway, etc.

Common symptoms

Shortness of breath and difficulty breathing

Causes of tracheal and bronchial stenosis

The disease is common after tracheotomy. When the tracheotomy site is too high, the first cartilage ring is damaged, which can cause annular cartilage erosion, inflammatory lesions and severe narrowing of the subchondral cartilage. During tracheotomy, excess anterior wall tissue of the trachea is removed, and a large amount of it can form in the future. Granulation tissue and fibrous scar tissue, the tracheal tube compresses the anterior wall of the trachea, causing the tissue above the incision to collapse inward and the pipes connected outside the tracheal tube to overstress the tracheal wall, causing the tissue to compress and erosion, which can form fibrous scar tissue in the future; in addition, To close the tracheal cavity, the tracheal catheter balloon is inflated too much and the pressure is too high. It can also compress the entire circumference of the tracheal wall, causing tissue erosion and necrosis. In severe cases, ring scarring stenosis may be formed in the future, or tracheoesophageal fistula and innominate arterial fistula. . The latter two cases have very high mortality rates. Therefore, when performing tracheotomy and intubation, attention should be paid to the tracheotomy site. It should not be too much to remove the anterior wall tissue of the trachea. The size and length of the tracheal tube should be appropriate. It should not be too high, and the connecting pipes should be light and soft to reduce the incidence of complications of tracheal stenosis.

Trachea and bronchoconstriction are also common in airway lesions, such as benign or malignant tumors in the trachea and bronchus, inflammatory granulomas, and foreign bodies in the airway; external airway compression, and airspace occupying lesions, such as esophageal cancer, thyroid cancer, abscess, Hematoma or gas compression; airway wall diseases, such as tracheal tumors, esophageal cancer, or other chest tumors caused by radiotherapy after tracheal wall injury, trachea softening, and recurrent polychondritis.

Clinical manifestations of tracheal and bronchial stenosis

Common symptoms are shortness of breath and dyspnea caused by airway obstruction. It can be seen that there are different degrees of dyspnea, inspiratory or expiratory dyspnea, or both. It is often accompanied by shortness of breath, wheezing, cough, sputum, and the sputum is sticky and laborious. Excessive physical activity and increased respiratory secretions, often wheezing. In cases where tracheotomy and intubation have been performed, the above symptoms should be considered first. CT of the neck and chest or anterior, posterior, lateral and oblique tracheal tomography can clearly show the stenosis, degree, length and morphological changes.

Patients with bronchial stenosis may have weakened or disappeared thoracic respiratory motion and tremor, which may be dullness, auscultation, low or disappearance of respiratory sounds, and dry and wet rales.

Examination of trachea and bronchi

1. X-ray tracheal tomography, cervical and chest CT

X-ray tracheal tomography can find narrow trachea; cervical and chest CT can clearly show the involvement of airway lesions in the lumen, tube wall and surroundings, and measure the length and width of the stenosis to choose the appropriate treatment method.

2. Endoscopy

Can effectively find narrow trachea and bronchial lesions.

3. Tracheal lipiodol contrast examination

Although it is valuable for diagnosing tracheal stenosis and understanding the scope of stenosis, it is worth noting that it may increase the risk of tracheal obstruction.

Diagnosis of tracheal and bronchial stenosis

Dyspnea due to tracheal and bronchial stenosis is often misdiagnosed as bronchial asthma, chronic obstructive pulmonary disease, and cardiac insufficiency, which requires attention. The diagnosis can usually be confirmed by clinical symptoms and CT, X-ray examination or endoscopy.

Treatment of tracheal and bronchial stenosis

1. Circular resection of the anastomosis is the main treatment of tracheal stenosis in the past. Transbronchoscopic electrosurgical or laser incision combined with balloon dilatation is safe, minimally invasive, and effective.

2. For cases where the tracheal cavity is blocked only by granulation tissue, bronchoscopy can be used to remove the granulation tissue by freezing or combined laser, high-frequency electric knife, APC and other thermal ablation techniques or cut the trachea and scrape the granulation tissue under direct vision. Ventilation went smoothly.

3. For stenosis caused by softening of the trachea wall due to long-term compression of adjacent organ masses, on the basis of relieving compression, the softened area is fixed with rib pieces to support the stenosis; it can also be implanted in the trachea to release the stenosis. . For emergency patients with narrow airways, a tracheal stent can be placed to relieve breathing difficulties, and then the cause can be treated.

4. If the stenosed area is too long, it is not suitable for resection of the lesion and the end-to-end anastomosis can be done by placing a tube inside the trachea and leading it out through the stoma to relieve tracheal obstruction and ensure smooth breathing.

5. Removal and contralateral anastomosis of tracheal lesions in infants and children must be cautious. Because the infant or child's trachea is less resistant to end-anastomotic tension than adults, and the trachea has a small lumen diameter and poor tolerance to edema, surgery should be postponed as much as possible.

6. During the treatment process, attention should be paid to anti-infective treatment. Infection can aggravate the degree of tracheal obstruction, increase the difficulty of treatment, and cause dangers such as complete obstruction of the trachea.

7. For tracheal extubation, tracheal reconstruction surgery is generally required if the tracheal stenosis is no longer required to undergo mechanical breathing therapy. In cases where ventilation function has not been fully recovered, conservative treatment measures such as tracheal dilatation, tracheal reconstruction, intubation or placement of a trachea to support the trachea cavity in the narrow section can be performed regularly to maintain the ventilation function to prolong life.

8. Other surgical methods used to treat this disease include endotracheal strip expansion, airway balloon dilatation, intratracheal laser technology, and tracheobronchial stent technology. The advent of these technologies has made the treatment of tracheobronchial stenosis and occlusion simple, safe, and extremely effective. If scar lesions such as tuberculosis and trauma are caused, probe strips and balloon dilatation therapy are mainly used, and foreign objects such as stents are avoided as much as possible. If the trachea and bronchi are completely occluded, it is necessary to apply laser to open the blocked airway on the basis of strict selection of indications, and then use probes or balloon dilation to maintain airway patency, or place a replaceable air according to the actual situation. Road stent, such as silicone stent, etc., remove the stent as needed after the condition is stable. For tracheobronchial stenosis caused by malignant tumors, airway laser and airway stent placement are mainly used. These methods can restore the ventilation function of occluded or narrow trachea and bronchi in a very short period of time, significantly improve the working ability of patients, improve their quality of life, extend the survival time, and gain valuable time for the treatment of the primary disease.

Prevention of tracheal and bronchial stenosis

The prevention of this disease is mainly early detection, early diagnosis, and early treatment of primary diseases. For the diseases that occur in the trachea and bronchus, the possibility of causing airway stenosis should be considered, and the occurrence of airway stenosis should be prevented in advance. At the time of examination, although tracheal lipiodolography is valuable for diagnosing tracheal stenosis and understanding the scope of stenosis, it is worth noting that it may increase the risk of tracheal obstruction. Do not use unless the diagnosis cannot be clearly confirmed by other examination methods.

In addition, children have short necks, small tracheal lumen, soft cartilage, and anatomical marks such as thyroid cartilage and ring cartilage are difficult to figure out. Children are often considered to have a high risk of surgery, many complications, and difficult postoperative care. After the aggravation, the operation must be considered as a last resort, which artificially increases the difficulty of the operation. For patients in need of surgery, if the blood oxygen is below 80%, surgery should be performed as soon as possible. Before the operation, tracheal intubation should be performed conditionally. The tracheal intubation takes a short time and has little damage, and it can relieve breathing difficulties in time and effectively remove the trachea. And lung endocrine, to avoid suffocation during surgery, reduce complications such as pneumothorax and mediastinum. After tracheal intubation, emergency surgery becomes common surgery, which is helpful for trachea search and intraoperative operation, which improves the safety of the operation and is more convenient for rescue treatment.