For early stage laryngeal cancer (vocal cord cancer), traditional methods mostly adopt laryngeal laceration vocal cord resection, partial laryngectomy or radiation therapy, with 5-year survival rate reaching 90%-95%, but all of them have disadvantages such as large trauma, long treatment time and high cost. Laser minimally invasive surgery for early laryngeal cancer is the development trend of laryngeal cancer surgical treatment today, because it has short treatment time, can minimize vocal cord tissue damage and laryngeal frame structure destruction, and can better protect the vocal and respiratory functions of the larynx by reducing trauma based on complete removal of the lesion. There are many laser treatments for early laryngeal cancer, including CO2 laser, Nd-YAG laser, KTP laser, semiconductor laser, holmium laser, etc., among which CO2 laser is the most commonly used. Vocal cord structure: The vocal cord structure can be roughly divided into the epithelial layer (a compound squamous epithelium), the lamina propria (the superficial layer is the Renk layer, a loose connective tissue; the middle layer is the elastic fiber layer, the deep layer is the collagen fiber layer, the elastic fiber layer and the collagen fiber layer form the vocal ligament) and the vocal cord muscle. Microscopically, the vocal folds can be divided into five layers, in order from superficial to deep: the first layer is the epithelial layer; the second layer is the Renk layer; the third layer is the elastic fiber layer; the fourth layer is the collagen fiber layer, and the fifth layer is the muscle layer, i.e., the vocal fold muscle. Surgical method General anesthesia with transoral tracheal intubation. No sterile cavity sheet is required, but the head is wrapped and dental pads or gauze are placed in the mouth to protect the upper teeth and avoid loose teeth. Different models of laryngoscopes are selected according to the difficulty of laryngeal exposure and other related conditions, and the laryngoscope is supported to fully expose the laryngeal cavity and vocal fold lesions. A saline gauze with thread covers the tracheal intubation balloon to prevent burning caused by the laser breaking the tracheal intubation balloon. The tracheal cannula is not supplied with pure oxygen to prevent the tracheal cannula from breaking and causing combustion and blast. The spot size is adjusted and the CO2 laser is guided by a red helium-neon light for vocal cord cancer resection. The output power (3-10W) is adjusted according to the resection speed. Determination of surgical margins: For very superficial, limited tumors, the spot is 1 to 2 mm from the cancer margin for CO2 laser resection of vocal cord cancer. Excision of precancerous lesions 1 to 2 mm from the edge of the lesion. For bulging vocal cord cancer, the light spot is 2 to 3 mm from the edge of the cancer CO2 laser excision of vocal cord cancer. For infiltrating and bulging vocal cord cancer, the light spot is more than 3 mm from the edge of the cancer to remove the vocal cord cancer. Vocal cord cancer laser treatment focus: The anterior and posterior margins of laser resection of vocal cord cancer are easy to master, but the depth of basal resection is not easy to control. Influencing factors of basal resection depth: (1) To judge the depth of tumor infiltration, superficial vocal cord cancer with shallow infiltration should be resected together with shallow depth of vocal cord; bulging and infiltrating vocal cord cancer with deeper invasion of vocal cord should be resected deeper when resecting vocal cord cancer. (2) Intraoperative observation of whether the laser resection of vocal cord cancer cuts into normal tissues requires rich clinical experience. For bilateral vocal cord cancer, or vocal cord cancer invading the anterior union, the laryngeal cavity should be sutured with silicone membrane to prevent adhesions when the anterior union is cut to the contralateral vocal cord. (It is not reliable to apply medical chitosan and mitomycin locally on the anterior union wound to prevent adhesions during surgery). CO2 laser resection of vocal cord cancer surgical margin 1. Vocal cord precancer, carcinoma in situ: 1~2 mm. 2. Superficial vocal cord cancer: 2~3 mm. 3. Raised, infiltrative vocal cord cancer: 3~5 mm. Postoperative treatment of positive pathological margin Close follow-up and observation once a month, and enhanced CT examination once every 3 months. Postoperative supplemental radiotherapy. Partial laryngectomy Postoperative management and follow-up Discharge on the 1st postoperative day and take oral antibiotics for 3 days. First follow-up 1 to 2 weeks after surgery: review pathology report. If the cut edge is positive (with tumor exposure), radiotherapy is feasible, or close postoperative follow-up, if there is recurrence, then deal with it. Postoperative follow-up in six months: Monthly follow-up, during which different degrees of granulation will be found in the vocal cords on the operated side, most of which will disappear automatically within 3 to 4 months, and individual granulation will disappear within six months. If the granulation does not disappear within six months, surgical excision is recommended, and consideration should be given to whether it is a postoperative recurrence. Follow-up within six months to one year after surgery: once in 1 to 2 months. Follow-up after 1 year after surgery: once in 1~3 months. Advantages of laser resection for laryngeal cancer The surgery is less invasive, no tracheotomy is needed, and the earliest hospitalization can be discharged in two days, and the cost is low. The postoperative recovery is also fast and has little impact on the body. However, the resection area of laser laryngectomy for laryngeal cancer is limited and not as large as that of partial laryngectomy. If laser surgery is performed reluctantly without mastering the indications for surgery, the laryngeal cancer may not be removed cleanly and may recur after surgery. Vocal fold healing process after vocal fold cancer resection.