laryngopharyngectomy

The laryngeal and pharyngeal tumors are concealed due to their status, and the symptoms are very mild and difficult to detect early. In the operation, it is necessary to consider the more thorough removal of the cancer, and the repair of the defect after the resection of the major laryngeal and pharyngeal. Choose the appropriate resection according to different situations. Treatment of diseases: laryngeal cancer Indication 1. The laryngeal and posterior wall cancer is often not directly related to the larynx. It can be used for partial laryngectomy and tongue flap repair. 2. Laryngeal fossa, posterior ring and esophageal entrance cancer with laryngectomy and laryngeal angioplasty. 3. Laryngeal external laryngeal cancer involving laryngeal and pharyngeal cavity with full laryngectomy, the same method as before. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation 1. The accurate position of the cancer in the throat and throat should be carefully checked before surgery, so that the appropriate size, height and low flap can be taken for the corresponding parts for repair. 2. If the patient has difficulty breathing, it is difficult to perform intratracheal anesthesia during operation. Before the operation, a tracheal incision should be made under the thyroid isthmus to avoid the blood supply of the flap. If a straight tracheotomy is made, the blood supply to the flap will be affected, making the repair operation difficult. Surgical procedure The first phase: 1. Incision: A rectangular incision made in the front of the neck. The incision is toward the healthy side, the upper edge is at the hyoid bone, and the lower edge is under the annular cartilage. 2. Exposing the larynx: The larynx is exposed in the same manner as the whole laryngectomy, and the trachea is cut at the lower edge of the annular cartilage. 3. Enter the upper part of the throat: from the hypoglossal bone into the throat and throat, after entering the throat, will be pulled out, that can clearly see the cancer. 4. Separate and remove the throat and throat and throat: separate the laryngeal and throat laryngeal cancer from the top to the bottom, and cut off at the level above the esophageal entrance. If the pharyngeal mucosa is still good, the part may be retained, but a margin of safety should be left. 5. Cut off the esophagus: If the cancer has invaded the esophageal orifice, the upper end of the esophagus can be removed together. 6. Flipping into the flap: The flap is turned into the resected throat and repaired, and the wound is sutured with a chrome gut or a fine thread. 7. Neck side skin grafting: skin damaged by the healthy side of the neck, repaired with a sectional skin. 8. Filling the wound: A vertical fissure is left in the anterior portion of the neck, which is filled into the throat and throat with an iodoform gauze, and the flap is compressed. Before filling, a nasogastric tube should be placed for postoperative feeding, and the neck should be pressure-wrapped to avoid bleeding. The second phase: After 2 to 3 weeks, the second phase of closed fistula surgery can be performed. Cut the pedicle of the flap at the fistula, suture the mucosa of the throat and pharynx and the skin of the neck in two layers, and close the mouth. complication Pharyngeal fistula: is a common early complication after laryngeal and laryngeal cancer resection. If treatment and care are not appropriate, it will not only cause pain to the patient, but also cause difficulties in further treatment and care. Therefore, how to effectively treat the patient is a problem worthy of attention.