Arslan-Serafini technique

Since Arslan and Serafini reported the reconstruction of tracheal-pharyngeal anastomosis in 1972, many scholars have continuously improved the surgical methods, and the surgical effect has gradually improved. It has become one of the methods of laryngectomy after laryngectomy. The basic principles of surgery are: 1 ring-pharyngeal-anaesthesia-lingual bone anastomosis: remove the upper part of the annular cartilage of the larynx, retain the epiglottis, hyoid bone, lift the ring cartilage with the hypopharyngeal mucosa, the epiglottis lower margin, and the hyoid bone. 2 ring-pharynx-eclear anastomosis: remove the upper part of the laryngeal cartilage, remove the hyoid bone, the epiglottic anterior space, retain the unaffected hypopharyngeal mucosa, partial epiglottis, and tongue root anastomosis. 3 tracheal-pharyngeal anastomosis: the first or second tracheal ring above the throat, the tracheal ring and the hypopharyngeal mucosa, epiglottis, hyoid or tongue roots. Treatment of diseases: epiglottic cysts Indication Tracheal (loop)-pharyngeal anastomosis is suitable for: 1. The cancer is limited to the bilateral vocal cords, the anterior union, the larynx, the ventricular zone, and the root of the epiglottis. 2. Glottic cancer invades the subglottic area no more than 1cm. 3. Not suitable for partial laryngectomy. Contraindications 1. The cancer has invaded the thyroid cartilage plate, the anterior larynx, the thyroid, and the neck. 2. The cancer invades most of the epiglottis, the epiglottis gap, the epiglottis, and the hyoid bone. 3. 70 years old or older, infirm, suffering from cardiopulmonary dysfunction. Preoperative preparation 1. General preparation for the same laryngectomy. 2. Advise the patient in advance that there may be varying degrees of swallowing dysfunction after surgery, and aspiration should be performed in preparation for inflation of the tracheal cuff before swallowing. 3. Insert the nasogastric tube the same morning. Surgical procedure Incision A vertical incision in the midline of the neck. From the lingual bone to the sternum concave or T-shaped incision, the flat lingual bone is cut horizontally at the upper end of the vertical incision. 2. Separation In the midline, the anterior cervical fascia and the band muscle were cut and separated, and the thyroid gland was cut off. The thyroid gland was separated from the two sides, and the thyroid cartilage, the annular cartilage and the cervical trachea were exposed, and bluntly separated around the trachea. 3. Cut off the trachea (ring) From the first tracheal ring or the upper edge of the annular cartilage, it is obliquely cut from the front lower to the upper rear, and the throat is separated from the anterior wall of the cervical esophagus from bottom to top. Cut the bilateral ring joints and the lower pharyngeal muscles, peel and cut the piriform fossa into the throat and throat. 4. Ligation of blood vessels The superior laryngeal artery and vein were ligated near the upper corner of the thyroid cartilage. 5. Cut the throat The upper thyroid cartilage was cut off, and the upper edge of the flat thyroid cartilage was cut horizontally to the periosteum of the thyroid gland. The lower edge of the epiglottis was cut and cut to the sides, and the throat was removed. If you want to enter the road from the hyoid bone, you can cut and separate along the upper edge of the hyoid bone. At the same time, dissect the anterior epiglottis, pull the hyoid bone down, cut into the disgusting valley and enter the throat and throat. At this time, the hyoid bone and the epiglottic space can be placed. 2/3 of the epiglottis is removed together with the larynx. 6. Tracheal-pharynx Firstly, the lower edge of the inferior pharyngeal mucosa and the end of the tracheal orifice are sutured with a thin wire. The mucosa is turned over to the end of the tracheal to cover the cartilage, and is sutured to both sides of the broken margin. The sides of the throat are sutured up and down to form the anterior wall of the pear-shaped fossa, and the pharynx is narrowed. Raise the head to reduce neck tension. Use the thin wire to continue suturing the tracheal orifice and both sides of the pharyngeal mucosa, and gradually close the tracheal pharynx. Use a thick thread or a gut line to pass through the center of the tracheal end (ring). The mucous membrane is pierced and then passed under the mucosa of the epiglottis. The pericardium is worn out, about 0.5 from the central suture on both sides of the same method. Each of the cm penetrates into a suture, and the surgeon and the assistant simultaneously draw and suture the three sutures. At this point, the tracheal-pharyngeal-epharyngeal-lingual anastomosis is completed, and the banded muscles and the thyroid gland separated on both sides are sutured in the midline. The front wall of the trachea. 7. Flush the wound and place the drainage strip Rinse the wound with saline to check for bleeding. If there is bleeding, stop the bleeding and put it into the subcutaneous drainage tube. 8. Close the incision Suture the skin and skin in turn. 9. Replace the tracheal tube After the anesthesia is awake, the anesthesia cannula is removed and the tracheal cannula is placed. complication 1. Subcutaneous infection in the neck is a common complication, which occurs mostly in the early postoperative period, and also occurs in the first half or one year after surgery. It is mainly caused by anastomotic suture stimulation. After the suture is removed, the incision heals quickly. In order to prevent such complications, the suture is reduced during the operation, and the gut is used in an anastomosis. When using a pull, try not to use 2 or 3 pieces. 2. Aspiration pneumonia: Intrapulmonary infection caused by postoperative swallowing insufficiency. If a tracheal tube with a balloon is used, it can prevent aspiration and remove the balloon after the swallowing function is completely restored. Once pneumonia occurs, systemic antibiotics should be applied immediately, and the attraction of endotracheal secretions should be enhanced. Intratracheal drug instillation can be controlled. 3. Pharyngeal fistula: rare, preoperative high-dose radiotherapy, postoperative subcutaneous infection and other causes can cause pharyngeal skin spasm. The method of treating pharyngeal fistula is the same as the pharyngeal fistula after total laryngectomy. 4. Anastomotic rupture of the tracheal prolapse: due to excessive tension of the tracheal-pharyngeal anastomosis caused by suture fracture, tracheal cartilage ring tear, or local infection can cause anastomotic rupture. The small rupture can heal itself after strengthening the local dressing change. When the rupture is large or nearly completely split, the tracheal prolapse can be formed. At this time, the cervical trachea retracts to the sternum, causing a large accumulation of hypopharyngeal and tracheal secretions. At the neck of the wound, this should be handled as appropriate. If there is no obvious infection, the trachea can be lifted early, and the tracheal-pharyngeal anastomosis should be repeated. The first-stage closed wound has a good hope. If the wound is severely infected, the antibiotic should be applied at the same time to strengthen the local dressing, so that the infection can be controlled. Consider re-synchronization.