Neoglottic reconstruction after total laryngectomy

New glottal reconstruction after total laryngectomy is a method proposed by Staffieri (1970). There have been constant improvements in the future. This tracheal-esophageal bypass surgery can achieve good vocalization after surgery. If the "new glottis" is moderate in size, it can be spoken after surgery, and there is no consequence of pharyngeal. It is a desirable vocal surgery. Treatment of diseases: thyroid cancer, laryngeal cancer Indication New glottal reconstruction after total laryngectomy is applicable to: 1. Glottis cancer 1T3 ~ T4; 2 vocal cords have been fixed; 3 epiglottic room with cancer and invasion of vocal cords; 4 invasion of thyroid cartilage or ring cartilage; 5 invasion of bilateral sacral cartilage; 6 out of the epiglottic space; 7 invasion of the epiglottis Tonggu root. 2. Glottic cancer 1 selective T3; 2T4; 3 invading the intercondylar region; 4 invading thyroid cartilage or ring cartilage; 5 extending to the subglottic. 3. Glottic carcinoma 1 extends to the glottis; 2 invades the cartilage. 4. Hypopharyngeal cancer 1T2 ~ T4; 2 piriform fossa and hypopharyngeal posterior wall were violated; 3 piriform fossa and posterior ring area were violated; 4 pear-shaped fossa and scorpion-like epiglottis were violated and one side vocal cord was fixed; 5 The throat was violated and the vocal cords were fixed. 5. Other 1 type of laryngeal cancer and hypopharyngeal carcinoma recurrence after radiotherapy; 2 thyroid cancer invades the throat; 3 other laryngeal malignant tumors; 4 glial closed incomplete long-term aspiration. Contraindications 1. Under the glottic cancer, the tracheal ring must be removed, and it is difficult to make a sound through the tracheal-esophageal shunt. 2. If there is a large range of cancer invasion in the posterior region of the posterior ring of the ring, it is difficult to form a "new glottis" by using the mucosa of the hypopharynx and the anterior wall of the esophagus, which may lead to surgical failure. 3. The marginal cancer occurs when the blemishes are disgusting and invade the inner wall of the piriform fossa. 4. Those who had undergone radiotherapy before surgery. 5. People with hypopharyngeal and esophageal mucosal atrophy. Preoperative preparation 1. Ideological preparation should explain to the patient and his relatives the accidents and prognosis that may occur during the operation, so as to relieve the concerns and strive for active cooperation. 2. Test blood routine, clotting time, blood pressure, electrocardiogram, chest X-ray (including esophageal barium meal) fluoroscopy, liver and kidney function. 3. Detailed examination of the local, if necessary, CT scan or MRI. 4. Local general preparation is the same as partial laryngectomy. Surgical procedure Cut the trachea The tracheotomy of the 4th to 5th tracheal rings is performed first, and the cut opening is located below the thyroid gland, and the thyroid gland is not separated to reduce the risk of tracheal cartilage necrosis. 2. Cut the trachea The lower end of the trachea resection has a high and low slope before the formation of the trachea. The lateral view of the trachea is sloped, placing the hypopharynx and the anterior wall of the esophagus on top, reducing the risk of swallowing. 3. Making "new glottis" - tracheal - esophageal fistula The esophageal adventitia is first fixed to the posterior end of the tracheal cartilage ring with two sutures, and is cut vertically in the middle of the anterior wall of the lower esophagus. The incision is 8 to 10 mm long, and the lower end of the incision is 2 to 3 mm above the tracheal end. The surgeon uses his fingers to reach into the hypopharynx to test whether it has passed through. The "new glottis" hypoglossal esophageal mucosa was sutured to the submucosal muscle layer with two needles on each side to form a fistula-"new glottis. 4. Fix the lower esophageal mucosal flap The mucosal flap of the anterior wall of the lower esophagus was covered on the end of the trachea. The new glottic-sacral canal was located in the center of the tracheal cavity, and the hypoglossal esophageal mucosal flap was sutured to the circumference of the tracheal margin. 5. Close the lower throat The lower pharyngeal defect is sutured according to the routine. 6. Close the incision Rinse the wound, place the drainage tube, suture the muscle, fascia, subcutaneous, and skin in turn to complete the tracheal-esophageal shunt. 7. Remove the anesthesia cannula, place the tracheal cannula, and dress with sterile dressing.