laryngopharyngeal tumor resection

Because of the hidden position of the throat and throat, it is generally impossible to see through direct inspection. It is also because of the large space occupied. Although it is the main point of the water valley, it is not a large cancer, and the symptoms are very light and difficult to detect early. The clinically diagnosed cases often have a wide range and are not very sensitive to radiation therapy, which makes the surgery have many difficulties. 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. And laryngeal cancer often has cervical lymph node metastasis, which increases the difficulty of repair. 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 There are mainly partial laryngectomy - tongue flap repair and laryngeal, laryngeal resection - laryngeal angioplasty, the method is as follows. (1) Partial laryngectomy - Tongue flap repair is performed in two phases. The first phase: 1. Cut the tongue flap in the tumor side neck, and make a mouth from the anterior border of the sternocleidomastoid muscle. When the upper edge of the cancer is reached, the incision is folded forward and a tongue-shaped flap is taken and then turned back to the anterior border of the sternocleidomastoid muscle and folded downward. This flap should not be too wide, and is most suitable from 4 to 4.5 cm. If it is too wide, difficulty may occur when suturing the neck wound. The flap and subcutaneous tissue were separated and hemostasis, and then protected with saline gauze. The advantage of this full-thickness flap is that the throat is swallowed and swallowed, which is superior to the fault-skin patch repair method. 2. Expose the ipsilateral thyroid cartilage wing down from the lingual thyroid muscle to expose the thyroid cartilage flap. For the convenience of exposure, the thyroid gland muscle can also be cut if necessary. 3. Cut the posterior half of the thyroid cartilage flap at the center or the outer 1/3 of the flap, cut the perichondrium, and cut and remove the cartilage. 4. Enter the laryngeal and pharyngeal cavity to open the perichonal membrane on the inner wall of the wing, from which it enters the throat and throat, and gradually expands the wound up and down. Before entering the throat and throat, it should be carefully examined through the laryngeal mucosa to avoid cutting into the throat and throat from the cancer. 5. Determine the extent of the cancer, and add a resection to carefully examine the extent of the cancer from the incision and remove it. If the infiltration is deep, the pharyngeal muscles must be removed together. A safe margin of normal mucosa should be retained during resection. 7. Suture the wound in the anterior portion of the incision. Although there is a skin defect, it can be sutured as long as it is free of the flap. The incision on the side of the neck should also be sutured as much as possible. Only the incision of the pedicle of the flap can be sutured during the second operation. 8. Fill the flaps. Fill the incision with iodoform gauze, press the flap tightly, insert it into the nasogastric tube, and pressurize the neck. The second phase: the second phase of surgery after 2 to 3 weeks after the first surgery. The skin of the leading edge of the wound and the pedicle of the flap and the mucous membrane below it are respectively cut open, and the mucosa and the skin are layered and sutured to close the wound. (B) laryngeal, laryngeal resection - laryngeal anesthesia adapted to a wide range of laryngeal cancer, and sometimes can also include cancer of the esophageal orifice. It is carried out in two phases, as follows. The first phase: 1. The front of the incision is made into a transverse rectangular incision. 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 to expose the larynx in the same manner as the whole laryngectomy, and cut the trachea at the lower edge of the annular cartilage. 3. Enter the upper part of the throat and enter the throat and throat from the hypoglossal bone. After entering the hypopharynx, the patient will be pulled out, and the cancer can be clearly seen. 4. Separation, excision of the throat and throat and throat. The laryngeal and throat throat cancers are separated from the top and the bottom, and are cut 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 the esophagus, such as cancer, has invaded the esophageal orifice, then the upper end of the esophagus can be removed. 6. Flip the flap into the resected throat and repair it. The wound is sutured with a chrome gut or a fine thread. 7. Neck side skin grafting The skin of the neck is damaged, and it is repaired with a fault skin. 8. Fill the front of the wound neck with a vertical fissure, and fill the throat with the iodoform gauze to compress the flap. 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.