Early symptoms of tracheoma

The clinical symptoms of tracheal tumors appear relatively late, so they are easily overlooked in the early stages. Symptoms vary depending on the size and nature of the tumor. Early patients often only experience irritating dry coughs, which are often misdiagnosed as swallowing or asthma. Tracheal tumors are divided into two types: benign and malignant. Most tracheal tumors in children are benign, while those in adults are often malignant. If the malignant tumor can be completely removed, the prognosis is still good.

1. Early and late clinical manifestations

Common early symptoms are an irritating cough with little or no sputum, sometimes with blood. When the tumor grows and gradually blocks more than 50% of the tracheal lumen, shortness of breath, dyspnea, and wheezing will occur. It is often misdiagnosed as bronchial asthma and treatment is delayed. Late-stage cases of tracheal malignancy may present with symptoms such as hoarseness, dysphagia, tracheoesophageal fistula, compression of mediastinal organ tissue, cervical lymph node metastasis and purulent lung infection.

Treatment of tracheal tumors

1. Treatment principles

(1) Treatment of tracheal tumors requires complete removal of the tumor. Prevent recurrence and eliminate tracheal obstruction. In advanced cases where the tumor cannot be completely removed, airway obstruction should be alleviated or relieved and ventilation function improved.

(2) Small benign tracheal tumors, especially those with a thin pedicle at the root, can be removed by electrocautery under endoscopy. Either a tracheotomy is performed to remove the tumor, or a portion of the tracheal wall is removed along with the tumor, and then the tracheal defect is sutured.

(3) In case of malignant tracheal tumor or large benign tumor, it is necessary to remove the affected section of trachea and perform tracheal reconstruction.

(4) For patients with advanced malignant tracheal tumors that cannot be removed or are incompletely removed, local radiotherapy or chemotherapy can be performed according to the pathological type.

(5) Patients with concurrent infection should receive anti-infection treatment.

(6) Symptomatic supportive treatment.

3. Surgery selection method

1. Circular tracheal resection and end-to-end tracheal anastomosis The maximum length of tracheal resection should not exceed 6cm to 6.6cm. After the operation, the patient needs to lower his head and keep it fixed for about 10 to 14 days, and can raise his head only after 3 months.

2. Tracheal carina resection and reconstruction ① The entire lung and carina on one side are removed, and the trachea is anastomosed end to end with the contralateral main bronchus. ② The carina was removed, the trachea was anastomosed end to end with the right main trachea, and the left main bronchus was anastomosed end to side with the right bronchus intermedius. ③ Carina resection and right upper lobectomy, end-to-end anastomosis of the trachea and right main bronchus, and end-to-side anastomosis of the right intermediate bronchus. ④ The carina was removed, and the left and right main bronchi were anastomosed side by side, and then anastomosed with the tracheal stump. ⑤ Resection of the carina and replacement of the carina with tantalum wire silicone tube, etc.

3. Local tracheal resection and reconstruction. It is mostly used for patients with more limited lesions and less involvement of the tracheal wall. After resection, the defects in the tracheal wall can be repaired with materials such as pedicled bronchial valves, pericardium, pleura, skin, and fascia.

4. Bronchoscopy or tracheotomy tumor removal is used for benign tumors such as leiomyoma.

5. Artificial trachea is suitable for patients with a wide range of tracheal resection and difficult anastomosis of the other ends.