bubble_chart Overview

Tracheal stenosis can be caused by congenital factors (such as abnormal tracheal development) or acquired conditions, such as scar stenosis following various inflammations or trauma, long-term compression by surrounding masses (e.g., thyroid tumors) leading to tracheal wall softening and stenosis, post-tracheotomy or intubation stenosis, or stenosis after radiotherapy for adjacent lesions. In recent years, with the increased use of mechanical respiratory therapy and radiotherapy cases, tracheal stenosis caused by these two factors has become more common. Tracheal stenosis is an irreversible and progressively worsening condition. The only effective treatment is surgical resection of the lesion. Since the disease progresses over time, there is also a risk of sudden complete tracheal obstruction. Surgery should be performed as early as possible, and the surgical outcomes are consistently favorable.

bubble_chart Clinical Manifestations

1. Worsening may occur with breathlessness, difficulty breathing, increased physical activity, or increased secretions in the respiratory tract.
2. As the degree of stenosis worsens, progressive difficulty breathing develops, accompanied by wheezing during inhalation.
3. In cases of severe stenosis, the supraclavicular fossa, intercostal soft tissues, and upper abdomen may simultaneously retract during inhalation (triple retraction sign).

bubble_chart Diagnosis

1. Progressive: Obstructive dyspnea with wheezing during inspiration, severe cases present with three depressions sign.
2. Chest X-ray and tracheal tomography show tracheal stenosis.
3. Bronchoscopy reveals narrowing lesions.

bubble_chart Treatment Measures

1. Circular resection of the lesion with end-to-end anastomosis is the primary treatment for tracheal stenosis.
2. For cases where the tracheal lumen is obstructed solely by granulation tissue, the granulation tissue can be removed via bronchoscopy or by incising the trachea and scraping it under direct vision to restore smooth ventilation.
3. For stenosis caused by long-term compression from adjacent organ tumors leading to tracheal wall softening, after relieving the compression, rib grafts can be used to externally support and fix the softened area to overcome the stenosis.
4. For cases where the stenotic segment is too long to be suitable for resection and end-to-end anastomosis, a tube can be placed inside the trachea and brought out through a stoma to relieve tracheal obstruction and ensure unobstructed breathing.
5. Resection with end-to-end anastomosis for tracheal lesions in infants and children must be approached with caution. Because the tracheal anastomosis in infants or children tolerates tension less well than in adults, and the tracheal lumen diameter is smaller with poorer tolerance to edema, surgery should be delayed as much as possible.
6. During treatment, anti-infection therapy should be emphasized. Infection can worsen the degree of tracheal obstruction, increase treatment difficulty, and even lead to dangerous complications like complete tracheal obstruction.

Tracheal stenosis is treatable and preventable. For example, during tracheotomy, the incision site should avoid being too high to prevent damage to the first cartilage ring; excessive resection of the anterior tracheal wall should be avoided; the tracheal tube should be properly positioned to avoid pressure on the anterior tracheal wall; externally connected tubing should not be too heavy or rigid; and the tracheal tube cuff should not be overinflated or under excessive pressure. These measures can effectively prevent tracheal stenosis or reduce its incidence.

Tracheal stenosis is an irreversible condition with a progressive worsening trend. Therefore, except for infants and young children, surgical resection of the lesion with end-to-end anastomosis should be performed as early as possible. Tracheal stenosis is often accompanied by varying degrees of concurrent infection. Infection can exacerbate tracheal obstruction, and tracheal obstruction can in turn worsen infection, creating a "vicious cycle" that may rapidly lead to complete tracheal obstruction, putting the patient in critical condition. Thus, in treating tracheal stenosis, in addition to pursuing early surgical resection with proven efficacy, effective infection control is also crucial.

Although tracheal iodized oil contrast examination is valuable for diagnosing tracheal stenosis and assessing its extent, it carries the risk of worsening tracheal obstruction and should be used with caution.

bubble_chart Cure Criteria

1. Cure: After the lesion is removed, symptoms disappear and ventilation is unobstructed.
2. Improvement: Symptoms improve after lesion removal or tube placement.
3. No cure: Symptoms do not improve.