The principle of surgical treatment for laryngeal cancer is to preserve the function of the larynx as much as possible on the basis of complete removal of the tumor. When the tumor is so extensive that total removal of the larynx is not enough to remove the tumor, then total laryngectomy should be done, and articulation reconstruction should be done at the same time or later. We know that the larynx has many important functions, such as articulation, breathing, swallowing and protection. It is an important organ with multiple functions. There are three types of surgical methods for laryngeal cancer: one type is microscopic laser laryngeal surgery: laser surgery is more and more widely used in the treatment of laryngeal cancer. In recent years, our hospital has introduced Israeli-made Sharplan
CO2 laser equipment combined with microscope is used in microlaser laryngeal surgery, which makes the surgery of early laryngeal cancer reach the standard of minimally invasive surgery required by today’s clinical medicine and achieve good results. The advantages of microlaser laryngeal surgery for early stage laryngeal cancer are incisionless in the neck, small trauma, accurate and reliable, and fast recovery. Generally, patients only need to be hospitalized for 5~7 days, which means that the pain of patients is reduced and the hospitalization time is greatly shortened, and the economic burden of patients is also reduced. The indications for microscopic laser laryngeal surgery are early stage laryngeal cancer. We appreciate that CO2 laser resection of laryngeal cancer under microscopic support laryngoscopy should be limited to T1 lesions and some T2 lesions. Microlaser surgery for laryngeal cancer has been reported extensively abroad, and is widely used with satisfactory results. The 5-year survival rate of T1 lesion of vocal cord cancer is over 90%, which is consistent with the effect of laryngeal laceration surgery and radiotherapy. Our hospital has recently introduced the world’s most advanced German contact laryngoscope which can directly observe the pathological histological changes of the larynx, making the diagnosis of early laryngeal cancer more timely and reducing the pain and hospitalization time of patients. The other type is partial laryngectomy, which is mainly applied to patients with T1, T2 and some T3 lesions of laryngeal carcinoma of vocal fold type and patients with T1, T2, T3 and some T4 lesions of supraglottic laryngeal carcinoma. According to the lesion site and resection scope, there are vertical hemilaryngectomy, horizontal hemilaryngectomy, horizontal + vertical hemilaryngectomy, subtotal laryngectomy, etc. This is an operation based on the complete resection of laryngeal cancer, and the normal part of the larynx is safely preserved and restored to all or part of the larynx after repair. There is another category of total laryngectomy, because the laryngeal cancer in more advanced stage is not suitable for partial laryngectomy due to the extensive tumor, which accounts for about 30% of the patients. Therefore, surgery can cause different degrees of damage to laryngeal function while treating laryngeal cancer. Therefore, the postoperative rehabilitation of laryngeal cancer focuses on restoring laryngeal function as much as possible. Under normal circumstances, there is no bacterial infection in the trachea and bronchus because the nasal cavity and pharynx have the functions of heating, humidifying, dust removal and sterilizing the inhaled air. After laryngeal surgery, due to cervical tracheostomy, outside air enters the trachea directly, contaminating the tracheal mucosa and causing infection, thus increasing respiratory secretions. The same antimicrobial agent has a temporary effect
But it is difficult to control, after a long time, the respiratory tract is used to the new environment, the secretion can be gradually reduced. The treatment should pay attention to keep the air inside the house warm and moist, especially in the northern winter, indoor dryness, humidifier can be used to increase indoor humidity, so that the respiratory secretions remain thin and easy to cough out, and if necessary, expectorant drugs can be used. Most patients after partial laryngectomy have their functions basically preserved except for temporary breathing with a tracheal cannula. However, when breathing with a cannula, there is also the problem of `direct traffic between the trachea and the outside world. After total laryngectomy the trachea is permanently stomaed in the neck, the mouth and nose are no longer breathing and air is entering and exiting through the neck stoma. The digestive and respiratory tracts are no longer connected, ensuring no choking and coughing during swallowing, but at the same time the articulatory function is lost. Most patients do not need to wear a tracheal tube after total laryngeal surgery. Unless the surgeon confirms that a tracheal tube is no longer necessary, the tracheal tube should not be removed for a long period of time to prevent stenosis caused by scar contraction of the stoma. Whether with a tracheal tube or not, care should be taken to keep the stoma clean and hygienic to prevent sputum crusts from blocking the stoma and causing breathing difficulties. 2.Language function recovery: After partial laryngeal surgery, patients can speak as usual with only varying degrees of hoarseness. The problem is that patients after total laryngectomy cannot vocalize. In order to enable all laryngectomized patients to speak, there are currently three main methods of articulation reconstruction after total laryngectomy: the first is artificial laryngeal articulation, the second is esophageal articulation, and the third is tracheoesophageal articulation. The first kind of artificial larynx produces mechanical sound, which is troublesome to use and sounds with metallic sound, and it is expensive, so it is rarely used as the first choice. The second kind of esophageal pronunciation has the advantage that it can be pronounced without hand control and save the trouble of carrying, but only 1/3 of patients can learn to master this method of pronunciation. And this kind of pronunciation usually needs professional speech therapist to instruct. The third type of tracheoesophageal pronunciation is a popular pronunciation method in recent years. After the research and improvement by experts, its pronunciation effect is getting better and better, and it is also the method that is used more and more. Among this kind of articulation methods, the one that is more applied at present is the technique of reconstructing tracheoesophageal articulation after total laryngectomy (Blom-Singr) published by Professor Blom, a famous American speech pathologist, and Professor Singr, an expert in otorhinolaryngology-head and neck surgery, after more than ten years of dedicated research in 1978. This technique has provided an effective, simple, reliable, and error-free method of articulation for many laryngectomized patients to return to work and communication in society. This articulation method involves making a small hole in the cervical tracheostomy between the posterior wall of the trachea and the anterior wall of the esophagus, and then inserting a pronunciation tube. When the patient speaks, he or she blocks the anterior cervical tracheostomy with the thumb and can obtain satisfactory speech function. Because the valve of articulatory ventilation of the articulatory tube is one-way, that is to say, gas can only enter the mouth through the articulatory tube and articulate, while when eating and drawing water, food cannot flow into the trachea through the articulatory tube and cause mis-swallowing and choking, which reduces the chance of lung infection. In recent years, this surgical technique has been introduced and carried out in China, and the advantages of this surgical method are easy operation, fast recovery of speech function, high success rate of pronunciation, and no mis-swallowing and choking when the patient eats. The patient’s quality of life has been significantly improved. This surgical approach can be done simultaneously with total laryngectomy for laryngeal cancer (stage I completion) and also for patients who have undergone total laryngectomy and are still unable to speak, and stage II completion allows these laryngectomized patients to regain speech function. The success rate of patients with cervical clearance was 72%. In the past decade or so, this technique has been promoted and applied abroad, benefiting many patients with laryngeal aphonia, and has been well received by them. At present, there are tens of thousands of laryngeal patients in China. With the increasing promotion and popularization of this technology in China, more laryngeal patients will be benefited, thus freeing them from the pain of not being able to speak. 3.Swallowing and protection function: When people eat, the laryngeal vocal valve closes to prevent food from entering the respiratory tract. After total laryngeal surgery, breathing and eating are separated and there is no problem of eating misophagy. Only after partial laryngeal surgery, because the surgery changes the original physiological structure, it takes a period of practice for the patient to adapt to the new environment and get used to eating under the new anatomical conditions. This is mainly done by eating several times a day and in small amounts. It is difficult to avoid choking and coughing at the beginning, but with patient and persistent efforts and practice, the majority of patients can resume normal eating. Another important aspect of rehabilitation is psychological rehabilitation. This requires the help of the whole society and the patient’s own efforts, the understanding and cooperation of colleagues and family members, the patient’s ability to understand and actively cooperate with the doctor’s treatment, and the patient’s confidence to overcome and overcome the postoperative discomfort.