The use of laser surgery in laryngeal surgery began in the 1960s, and the application of laser for the successful treatment of laryngeal cancer was pioneered by Strong and Jako in 1972. The bulk case reports about laser treatment of laryngeal cancer show that laser surgery has the advantages of less surgical trauma, no intraoperative tracheotomy, fast postoperative recovery, good postoperative pronunciation quality and low cost, and its oncological results are not significantly different compared with those of surgical procedures. At present, laser treatment for early laryngeal cancer is gradually increasing in China and abroad.
I. Indications
1.T1.T2 acoustic laryngeal cancer.
2.T1 supraglottic laryngeal carcinoma located above the level of hyoid bone in the epiglottis.
3.T1 supraglottic laryngeal cancer limited to ventricular zone or aryepiglottic crease.
Contraindications
1.Involvement of laryngeal cartilage.
2.Vocal hilar laryngeal cancer with subglottis extension of more than 5mm or parglottic gap involvement.
3.Supraglottic laryngeal cancer involving the epiglottis valley, anterior epiglottis space or tongue root.
Pre-operative preparation
Before general anesthesia surgery, routine laboratory and general examination, fiberoptic laryngoscopy, dynamic laryngoscopy and laryngeal CT examination. 6h preoperative fasting, 30min preoperative intramuscular injection of appropriate amount of atropine and luminal.
Anesthesia and position: general anesthesia, supine position.
V. Surgical steps
1.Apply the support laryngoscope to expose the vocal fold.
2. Aim the operating microscope with an objective focal length of 400 mm or 350 mm at the laryngeal lesion area, and adjust the magnification (1.5-2.0 times) and focal length of the microscope until the lesion is clearly visible.
3.Applying CO2 laser, Nd-YAG laser, semiconductor laser or KTP contact laser, etc. according to the size and location of the tumor, the following Eckel 4 types of surgery are performed: Type I: Only the mucosa of the vocal cord is removed while the vocal cord muscle is preserved, which is suitable for in situ cancer. Type II: Resection of the entire vocal folds on one side, preserving the contralateral vocal folds and bilateral arytenoid cartilage. Type III: Resection of bilateral vocal folds and anterior union, which may also include one side of the arytenoid cartilage, from the external to the thyroid cartilage plate and down to the level of the cricoid cartilage. Type IV: also known as laryngectomy, all structures in the larynx are removed and only the thyroid cartilage plate is preserved.
Intraoperative points of attention
1. The resected lesion must be fully exposed.
The tumor should be excised as a whole. After excision, multiple tissue biopsies should be performed at the cut edge, and after finding the residual tumor, extensive excision should be performed again until the cut edge is negative.
3.The smoke should be sucked out by suction device in time to avoid affecting the visual field.
4.Laser surgery should avoid accidental injury to normal tissues and anesthesia catheter to prevent respiratory burns caused by ignition of anesthesia gas.
5.The laser excision wound should be coated with fibrin glue to reduce postoperative bleeding and granulation formation.
VII. Postoperative treatment
1. Postoperative antibiotics and hormones are routinely given to prevent possible infection and laryngeal edema.
2. Temporarily abstain from food and water after surgery, and change to semi-liquid diet or general diet after 6h as appropriate. Those who have mild aspiration can be given viscous food first, and then start normal diet after the aspiration disappears after short-term training.
VIII. Complication prevention and control
1. Intraoperative and postoperative bleeding rarely occurs, and the key to prevention is to stop bleeding thoroughly during surgery.
2.Laryngeal edema rarely occurs, and can be prevented by appropriate hormone therapy after surgery; if laryngeal edema occurs and respiratory distress is severe, tracheotomy is feasible.
3.Mild aspiration may occur for a short period of time in cases of epiglottidectomy, which can disappear by itself after swallowing exercise.
4.Laryngeal stenosis mostly occurs in the early stage due to granulation tissue hyperplasia, and the dyspnea is usually not obvious, and it can mostly subside by itself after 3 months. If the granulomatous hyperplasia is more serious, surgical clamp removal or laser cautery treatment is feasible.
5, respiratory burns rarely occur, the prevention is to avoid the use of flammable anesthetic gas and intraoperative application of wet saline gauze or cotton to protect the anesthetic catheter.