In the end, it collapses to the point that it is a wonder to be alive.

And above all, there is still no cure for it. In medical therapy, even if you can cover up a mild cough,A fundamentally collapsed trachea cannot be widened.Even if you don't have specialized knowledge, you can't imagine that the collapsed windpipe will expand with medicine, right? Then, with a simpler idea, if it collapses, it might be better to open it surgically, but I can't find the means to do so.

how do i spread it?

In the old days, there was a method of sewing the trachea to shrink it, and a method of cutting a syringe jacket into a spiral or C shape and fixing it to the outside of the trachea and suturing it (prosthesis method). This kind of method is introduced in textbooks, but the results are not as good as expected, and there is no one who performs surgery with this method at present.

Also, you shouldn't. Do not.

 

I have also experienced failures. In addition, although he underwent surgery using this method at another hospital, he developed dyspnea half a year later, and a year later, he was in continuous pain every day, and had to undergo another surgery at his request. This was the very embodiment of the word misery, a sight that made you want to cover your eyes. Rejection caused severe granulation tissue growth around the trachea, and the inside of the trachea became so thick that the core of a ballpoint pen could barely fit inside. It will end up. It was really bad.

 

On the other hand, there is also a method called a stent method, which inserts a metal expansion device into the lumen of the trachea under endoscope or X-ray fluoroscopy. Currently, endotracheal stents for dogs are on the market in the United States and are also available in Japan. The technique is very simple. If you push out the stent that has been contracted into the trachea under anesthesia, it will automatically expand in the trachea, so it can be completed in a very short time. However, some problems have been pointed out.

 

First, since the trachea is originally very sensitive, it is necessary to insert a foreign object into it. For example, I think that everyone has the experience of accidentally swallowing a grain of rice into the trachea while eating. Just imagining the pain at that time, the state of the cough, it seems like I'm going to cough. Coughing can be exacerbated by placing long stents into the sensitive tracheal lumen. In addition, it is possible that granulation tissue enters the trachea after attachment and further narrows the trachea.

 

Next, it is pointed out that metal stents may cause metal failure due to three-dimensional movement of the neck. And once you put it in, it's impossible to take it out. Also, although it depends on the shape of the stent, there is a problem with the means to stop it at any place. In human doctors, the stent method is the mainstream treatment for trachea/bronchomalacia, a disease similar to tracheal collapse in dogs. Silicone stents, called dynamic stents, have already established themselves as the gold standard, and this seems very ideal because it can be made to patient-specific sizes using, for example, CT.

However, if you listen to the voices of doctors in the field, the opinion that they do not want to use it is still conspicuous.

It is not something that can be maintained permanently, and there are actually many problems such as phlegm removal and granulation tissue growth.

From the above, you will be caught in the "curse" that the collapse of the trachea cannot be cured.

 

For early cases, "let's see how it goes while treating it medically"

(I wonder if the trachea collapsed by the medicine will return to normal...)

 

"If you make me lose weight, it will heal."

(But I'm not fat...)

 

If this progresses to an intermediate level, "Let's try a little more internal medicine."

(I wonder how long I won't be able to sleep...)

 

And it's severe, "I've already given up. There's no cure."

 

This was the reality. Even today, it is considered one of the representative intractable diseases, in that it does not respond remarkably to internal medicine and that surgical treatment results are unsatisfactory.

So let's go back to the starting point. Why can't we simply expand the collapsed trachea? If a stent can't expand from the inside, why not from the outside?

The reason why the stent method failed was that the stent itself had not been sufficiently developed. Similarly, the reason why the prosthesis method has not become popular is that the development of the prosthesis itself, which satisfies various conditions, was insufficient.

 

Again, the primary lesion of tracheal collapse in dogs is, with very few exceptions, the posterior neck. I often see medium-sized dogs that pull hard when walking, and this is the part where the collar hits. As you can easily imagine, this part can freely move up, down, left and right, looking up at the owner, looking down, looking to the side, looking back, and even licking the buttocks. . The trachea is a flexible structure that can sufficiently follow this movement.

Therefore, the prosthesis placed in this part must also have sufficient flexibility. And while maintaining the power to expand the collapsed trachea firmly. Then, is there a prosthesis that satisfies all of these strict requirements: not too hard, not too soft, no tissue reaction after implantation, and size options for various dog breeds?

 

In Japan, there are Flexible Spiral Line Prostheses (FSLP) proposed in 1990 by Dr. Kogi, who has a practice in Osaka (named by me and approved by Dr. Kogi). I have also used it in nearly 20 cases, and the results are excellent. FSLP uses acrylic material for optical fibers and processes it into a spiral shape.

However, there was an objection that the material was not for medical use, and at present there was no official paper published by not only the inventor but also other researchers. In addition, from my experience, there was a drawback that it took time during the operation, and depending on the situation, it could become a little dangerous during the operation.

 

So I used this same material"Acrylic material for optical fiber"In 2000, we created an extremely ideal prosthesis that satisfies all of the above conditions and has excellent operability and safety. It exhibits a unique three-dimensional zigzag cylindrical shape.Parallel Loop Line Prostheses (PLLP)named.

The material is not developed for medical use like FSLP. However, the FSLP and PLLP that we have actually used have shown excellent performance over many years, so we investigated this material. As a result, we found that the material is mostly PMMA, and the surface is coated with a few microns of fluororesin. PMMA is a material used for intraocular lenses (lenses that are placed after the lens that has been removed during cataract surgery), and fluoropolymers are also unique in their low reactivity to living organisms. is used. Although it was not developed for medical use in this way, it turned out that the material was used for medical use. There are experimental implant cases and real cases that could be dissected after death. A pathological examination is also conducted at the same time, but even after a long time of nine years, there is almost no foreign body reaction, and it has been determined that implantation in the body is sufficiently possible.