Partial laryngectomy for glottic laryngeal carcinoma

Partial laryngectomy for glottic laryngeal cancer has become the first choice for supraglottic cancer, and it is suitable for cancers above the glottic plane. Depending on the extent of the tumor, a partial unilateral supraglottic resection or a supraglottic laryngectomy may be used. The functional effects of supraglottic laryngectomy were satisfactory. Postoperative vocalization and swallowing function were completely restored, respiratory function was mostly restored, and the oncology effect was good. Pan Zimin and other reports of 379 cases, the 5-year survival rate reached 81.3%. Treatment of diseases: laryngeal cancer Indication 1. The epiglottic room is cancerous and the former combination is not violated. 2, laryngeal marginal cancer, sickle-like epidemics, limited local cancer. 3, epiglottis cancer has violated the epiglottis, but did not invade the tongue and tongue. 4, room cancer does not invade the throat or the ankle joint activity is normal. 5, the cancer has invaded the gap before the epiglottis, but has not penetrated the periosteum of the thyroid or did not invade the thyroid cartilage. 6, invading the cervical lymph nodes, cervical lymph node dissection should be performed at the same time. Contraindications 1. Carcinoma invades the larynx, iliac cartilage, anterior union and piriform fossa. 2, the gap before the epiglottis is widely involved, affecting the thyroid cartilage plate. 3, old and frail, severe heart and lung dysfunction. Preoperative preparation It is the same as the general laryngeal preparation. If a cervical lymph node dissection is performed, the neck preparation area of the neck is expanded to the side of the double neck. Surgical procedure 1. Incision For adequate exposure, intraoperative exploration of cervical lymph nodes or cervical lymph node dissection, it is advisable to have a T-shaped incision in the neck, perpendicular to the upper edge of the thyroid cartilage, and the upper sternal notch; transverse incision of the upper edge of the thyroid cartilage from the side of the chest The leading edge of the mastoid muscle is locked to the anterior border of the other sternocleidomastoid muscle. For cervical lymph node dissection, the transverse incision should be extended to the mastoid tip. The T-shaped incision is extended in a T-shape or an I-shape on one side or both sides. 2, incision and separation of subcutaneous tissue The subcutaneous tissue was subcutaneously cut down to the platysma. 3, open the skin flap Separate and open the skin platysma muscle flap on both sides and above. At this time, the cervical fascia and band muscles can be seen. 4, cut off the muscle attached to the hyoid bone The hypoglossal muscles such as the sternohyoid muscle, the thyroid lingual muscle and the scapular lingual muscle are cut at the lower edge of the hyoid bone. The muscles attached to the hyoid bone are then cut. 5, explore the cervical lymph nodes First, the lymph nodes of the ipsilateral carotid artery are explored, and the anterior border of the sternocleidomastoid muscle is separated and pulled to the outside to expose the carotid bifurcation. For suspicious lymph nodes, the frozen sections are clamped and the frozen section is used to determine whether to detect the contralateral cervical lymph nodes or perform cervical lymph node dissection. 6, peeling thyroid cartilage The perichondrium was cut at the upper edge of the thyroid cartilage and peeled down to the middle of the thyroid cartilage. 7, remove the hyoid bone After the hyoid bone is free, the two sides of the hyoid bone are cut off, and the middle part of the hyoid bone is attached to the periosteum of the thyroid tongue, and the end of the operation is removed together with the upper half of the throat. 8, into the throat and throat Enter from the epiglottis, use a knife to cut from the upper edge of the hyoid bone to reach the upper part of the epiglottis. Use a rat tooth clamp to hold the epiglottis. Don't use force. Otherwise, it will be irritated. Do not hold the tumor tissue. Out, cut along the sides of the epiglottis, exposing the throat and throat. When the epiglottis has cancer invasion, the piriform fossa approach should be adopted, which should be entered from the non-invasive cancer or the lighter side of the lesion. 9, check cancer Use scissors to cut the soft tissue of the throat and throat along the sides of the epiglottis until the epiglottis is fully exposed and pulled out. At this time, the laryngeal structure above the vocal cords and the piriform fossa on both sides can be clearly observed, and the surgical procedure of the resection is determined according to the range of the cancer lesion. 10, removal of thyroid cartilage On the plane of the 1/2 border of the thyroid cartilage (corresponding to the level of the vocal cord), the upper 1/2 thyroid cartilage plate was removed, for example, the unilateral glottic plate was removed, and only one side of the thyroid cartilage plate was removed. 11, remove the tumor First, the cartilage in front of the contralateral cartilage of the tumor is cut open, and the sputum is directly connected to the larynx. Then, from the posterior and posterior, along the side wall of the larynx above the vocal cord, the anterior joint is cut, and the ipsilateral to the anterior union is cut according to the same method. . If the suspected sacral cartilage has been invaded by cancer, the sacral cartilage can be cut off at the same time. Finally, the laryngeal chamber, the ventricular band, the anterior union, the ankle disgusting, the epiglottis, the epiglottic anterior space, and the hyoid bone on the glottis are simultaneously removed. A frozen section of the cut edge is examined. 12, fixed vocal cords If the sacral cartilage has been damaged, the vocal cord of the disease side loses its ability to move, and postoperative aspiration can occur. To this end, the operation should be cut vertically from the intercondylar area to the midline of the posterior part of the annular cartilage, so that the affected side vocal cords are permanently fixed in the midline position, to avoid postoperative glottic insufficiency, resulting in long-term drinking water into the trachea. 13, repair the throat wound After the upper half of the larynx is removed, an arc-shaped wound surface is left on the upper edges of the vocal cords on both sides, and the thyroid cartilage film which is peeled off in advance can be covered on the wound surface and fixed by suture. 14, fixed lower throat, closed throat and throat The patient's head is raised, the shoulders are flat, and the head is forward. Use a 7th thread from the center of the ring membrane to the inner surface of the lower half of the thyroid cartilage plate, and pass it out from above. The suture is then taken out through the muscular layer in the central mucosal margin of the hyoid bone. The suture line 4 is sutured with the mucosa of the tongue, and the throat and throat are closed. The upper and lower sutures are tightened so that the lower half of the throat is close to the base of the tongue, and the throat and the base of the tongue are closed. 15, put into the drainage tube layered suture Two silicone drainage tubes were placed and sutured and fixed to the skin of the neck side, and the upper and lower muscles of the original cut bone were sutured, and then the skin and the skin were sutured in turn. 16, put the tracheal tube After anesthesia is awake, remove the anesthesia catheter and place the tracheal cannula. complication 1. Saliva leakage: If the suture is improper, or the suture is split after infection, the saliva leaks in the wound, and the dressing is pressurized and bandaged, and the wound is healed in a short time. 2, perichondritis: because the cartilage membrane has been stripped before the thyroid cartilage plate is removed, and it is exposed to the throat and throat after repair, it is easy to be infected, once the infection should be cut open in time, otherwise the throat cavity is narrowed after surgery, the trachea can not be removed The cannula affects normal airway respiration. 3, intrapulmonary infection: if there is coughing symptoms after surgery, chest fluoroscopy or X-ray film should be taken in time. In order to prevent lung infection, patients with cough symptoms should not eat too early and take anti-infective measures.