Horizontal and vertical partial laryngectomy

Horizontal and vertical partial laryngectomy is an enlarged subtotal laryngectomy, also known as laryngeal 3/4 resection, which is mainly suitable for supraglottic cancer. After the laryngeal 3/4 resection, the first stage is repaired by nearby tissue. Part or all of the physiological function of the larynx is retained. Curing disease: Indication 1. On the glottic cancer, the tumor invades one side of the ventricular septum, the larynx, the vocal cords, the epiglottis, the epiglottis or the cartilage, or the anterior segment of the contralateral compartment. 2. The laryngeal squamous cell carcinoma invades the inner side wall of the piriform fossa on one side, and the ankle-like epiglottis and the facial part of the epiglottis. Contraindications 1. The contralateral vocal cords, the larynx, and the sacral cartilage have been invaded by the tumor. 2, thyroid cartilage has cancer invasion. 3, the tumor invades the inter-temporal area. 4. The tumor expands to the lower part of the sacral cartilage (post-loop area). 5, the tumor expands under the glottis, more than 5mm. 6. The gap before the epiglottis is widely affected. 7, cardiopulmonary dysfunction. Preoperative preparation 1, the general preparation is the same as laryngeal splitting. 2, the use of fiber speculum, video laryngoscope or microscopic laryngoscope to fully check the laryngeal, subglottic area, posterior ring area, parallel biopsy. 3, indwelling stomach tube and catheter before surgery. 4, the neck preparation range, the upper to the submandibular area, the upper side reaches the mastoid, the two sides reach the neck side rear, the lower reaches the upper chest, in order to prepare the neck lymph node dissection. Surgical procedure 1. Incision Generally, a semi-U-shaped incision is made, and the upper limit of the affected side is longer than the healthy side, that is, extending from the upper edge of one side of the sternocleidomastoid muscle to the plane of the ring membrane to the opposite side to the anterior border of the sternocleidomastoid muscle. If a cervical lymph node dissection is required, a transverse Y-shaped incision can be used, and a bilateral transverse lymph node dissection is performed with a double transverse Y-shaped incision. 2, pick up the flap Lift the flap together with the platysma to the plane above the hyoid bone. The flap was fixed with a suture and the lower flap was separated under the annular cartilage. 3, separation of the band muscle Separate and cut the anterior cervical band muscle at the midline. If the ligament is to be repaired by the band muscle, the sternohyoid muscle of the diseased side is preserved, and the sternohyoid muscle-tongue flap is formed when the midline is cut off the hyoid bone. 4, exposed thyroid cartilage separation outer bone coat After the anterior cervical band muscle was cut, the thyroid cartilage was exposed, the outer bone coat was cut horizontally at the upper edge of the thyroid cartilage, and the outer bone coat was peeled down to the lower edge of the thyroid cartilage with a small peel. 5, cut thyroid cartilage From the upper flank of the affected side of the thyroid cartilage, the 2/3 and 1/3 junctions on the midline to the thyroid cartilage were extended to the contralateral side. The cartilage was cut along this line with a circular saw or bone scissors, and the affected side of the cartilage flap was spared, and the rest was removed. 6, the hyoid bone approach After cutting the supraspinous muscle with an electric knife, the Allis tissue clamp grasps the hyoid bone, cuts the hyoid bone with the cartilage scissors on the outside of the small corner of the hyoid bone, pulls the hyoid bone forward and downward, and cuts the hyoid bone with the knife to cut the hyoid ligament. Enter the throat and throat, and then cut the periosteum of the thyroid under the two sides of the hyoid bone, you can see the epiglottis. 7, remove the tumor The epiglottis is pulled forward to fully expose the larynx, and the tumor size can be observed to determine the extent of resection. If the exposure is not enough, the laryngeal mucosa can continue to be cut on both sides of the epiglottis, and the scissors can be used to cut the anterior joint from the posterior horn of the larynx to the front side of the vocal cord, and then from the affected side to the sacral cartilage and vocal cord according to the situation. The edge or part of the annular cartilage is cut forward, and the healthy side meets here, or the affected side is a vertical half-throat, the healthy side is the upper part of the glottis, together with the epiglottis, hyoid bone, epiglottic anterior space, and even the base of the tongue, the affected side The inner wall of the piriform fossa is removed together, and the tumor and its safety boundary are required to be more than 5 mm. Frozen sections were taken to determine if the margin was positive to determine whether to perform an enlarged resection. 8, stop bleeding When cutting the sides of the periosteum of the thyroid tongue, the laryngeal movement and vein can be ligated, and the side clamp can be used to stop bleeding, and the active bleeding can be sutured and ligated. 9, pharyngeal muscle cut Under the pharyngeal mucosa, the pharyngeal muscle is cut vertically. 10, repair the glottal crack The pre-formed affected side cartilage flap (the full length of the affected side, the cartilage strip with a width of 0, 5 cm) was turned into the resected side of the vocal cord and sutured with a No. 0 filament thread. The front was fixed on the cartilage and fixed at the back. The piriform fossa was separated on the posterior plate to cover the suture on the cartilage flap. At this time, the patient was changed to light anesthesia, and the mucosa of the larynx was stimulated with a suction tube to observe whether the glottic closure was achieved when the vocal cords were active. If the glottic fissure is large, the banded muscle free muscle flap can be implanted under the mucosa of the piriform fossa on the cartilage flap, and the piriform fossa mucosa can be re-sewed. The sternohyoid muscle pedicle repair method: the sternohyoid muscle and the hyoid bone of the affected side are released together to form the sternum of the hyoid bone of the lingual bone, and the hyoid bone is turned to the affected side of the larynx, which will be in front of the pedicle of the hyoid bone. The suture is fixed on the ring or the cartilage arch, and the posterior suture is fixed on the posterior plate of the cartilage. At this time, the hyoid bone has been embedded in the affected side of the larynx to achieve the purpose of reducing the glottal split. 11, closed throat and throat The thyroid cartilage outer skin and the middle part of the hyoid bone were sutured with a No. 0 silk thread, and the pharyngeal mucosa on both sides was sutured with the mucosa on both sides of the tongue. The anterior cervical fascia and the band muscle were sutured to the submucosal layer of the tongue, and the band muscles on both sides were sutured in the midline. 12, flushing wounds Rinse the wound with saline, and if there is bleeding, stop bleeding. 13, placed the drainage tube Place two drainage tubes and pull them out from the skin on both sides of the lower neck to suture and fix the drainage tube. 14, incision suture Suture the skin and skin in turn. 15, ventilation tube casing After the anesthesia became shallow and the tracheal endocrine secretion was fully absorbed, the intratracheal anesthesia catheter was removed and the cuffed tracheal cannula was inserted. 16, dressing Put a sterile gauze on the wound and pressurize the neck