Tracheal laryngeal surgery

Tracheal laryngectomy, the method of replacing the upper part of the trachea, the main point is that after the total laryngectomy, the free neck segment of the trachea is raised upwards to the plane of the hyoid bone and the throat of the throat, so that the air in the lung passes through the upper part of the neck. , into the throat and throat cavity pronunciation. Treatment of diseases: laryngeal cancer Indication 1. Glottic cancer: The range of cancer is large, involving bilateral vocal cords, and the vocal cords have been fixed. 2. Glottic carcinoma: The lower boundary of the cancer does not exceed the lower edge of the cartilage, and does not pass through the ring membrane, and does not involve the anterior wall of the esophagus. Preoperative preparation 1. Before surgery, check the general health status, such as high blood pressure, heart and lung diseases, and whether the liver and kidney function are normal. 2. The exact part of the cancer should be carefully examined before surgery. If the lower edge has reached the neck of the trachea, this method should not be used. Surgical procedure 1. The anterior cervical line cuts the skin and subcutaneous tissue from the hyoid bone to the sternum. 2. Separate the anterior cervical fascia and muscles in front of the larynx and the upper part of the trachea. Cut the muscles under the hyoid bone under the hyoid bone. 3. Cut and ligature the thyroid isthmus, and peel off the leaves from the trachea, fully expose the cervical trachea to the sternum, cut the trachea at the fifth ring of the trachea, and insert the tracheal intubation with the balloon. 4. Separate and cut the ligament of the sternum and the thyroid thyroid muscle. The pharyngeal muscle was dissected along the thyroid cartilage flap, and the upper thyroid cartilage was exposed and sheared. The upper larynx artery was separated about 1/3 of the upper edge of the thyroid cartilage, and the superior laryngeal artery was isolated and cut and ligated. 5. Cut the trachea at the lower edge of the annular cartilage or at the first ring of the trachea. 6. Separate the throat from the bottom to the anterior wall of the esophagus, enter the throat and throat from the posterior part of the sacral cartilage, and cut the laryngeal mucosa to separate the larynx. 7. Cut off the epiglottis at the upper edge of the thyroid cartilage. If there is no cancer invasion, leave it in the throat and remove the throat. 8. Separate the trachea from the top to the bottom of the esophagus to the fifth annular plane of the trachea. 9. The broken edge of the inferior wall of the pharyngeal wall and the posterior wall of the upper end of the trachea are sutured with silk thread, and the entrance of the pear-shaped nest is sewn and inserted into the nasogastric tube. 10. Stitch the remaining epiglottis rupture margin with the anterior wall of the first ring of the trachea. The anastomosis and the tracheal anastomosis are lifted up to the hyoid bone, and the suture is tightened with a thick thread to raise the neck trachea to the position of the normal laryngeal vestibule. 11. Suture the anterior cervical muscle, anterior larynx and skin, and insert the tracheal cannula.

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