Postoperative care for total laryngectomy of laryngeal cancer

After total laryngectomy, patients need to wear a tube for a long time. After discharge, patients and their families should master the basic knowledge of tracheal tube care, cleaning and disinfection, such as checking the tightness of the laces that fix the tracheal tube every day, disinfecting the skin around the tube regularly and changing the dressing of the tracheal tube mouth in time. Remove the inner tube of the tracheal tube regularly every week, clean it thoroughly, especially the inside of the tube, which needs to be cleaned with a brush to keep the inner tube unobstructed. After cleaning, boil it for disinfection. After disinfection, wait for the tube to cool down and then put it back into the patient's throat.

Because breathing through a tracheal tube changes the original breathing method, the humidification and temperature regulation process of the upper respiratory tract is changed abruptly. The patient will lose a lot of water and temperature during breathing, which will cause the mucosa in the trachea and bronchus to dry and form dry scabs on the surface. Therefore, patients who have just been discharged from the hospital can maintain a suitable temperature (preferably 18-22°C) and humidity in the room. Cover the tracheal tube port with saline wet gauze to increase the humidity of the inhaled gas and prevent the inhalation of foreign matter. Regularly drip medicine into the trachea with saline to achieve the purpose of intermittent humidification in the trachea. If there is sputum in the trachea, the number of daily tracheal instillations and the amount of each instillation can be increased as appropriate, and antibiotics and expectorants can be instilled into the trachea at the same time. After the patient gradually adapts to the surrounding air temperature and humidity over time, the intratracheal instillation and the humidification and insulation of the room can be gradually reduced. Even if the patient has adapted to the changes in the surrounding environment, try to avoid crowded places to prevent cross infection.

Diet care

Since the epiglottis has been removed in patients who have undergone vertical partial laryngectomy, if they are not careful when swallowing, food will fall into the trachea and cause severe choking and coughing. Therefore, patients after laryngeal cancer surgery must undergo a long period of dietary training, eat small amounts and multiple times from small mouthfuls, and gradually switch from solid food to liquid food. Only after gradually adapting can they achieve a normal diet.

Postoperative pronunciation guidance:

Postoperative aphonia is an important factor in patients' anxiety and loneliness, so it is important to build confidence in patients and guide them to repeatedly practice pronunciation without a larynx. Start practicing with monosyllabic words, then pronounce overlapping sounds, such as "一一, 二二", etc., and gradually increase to disyllabic words, words, phrases, etc., and focus on daily language to increase patients' learning interest. Patients can be guided to learn to use the esophagus to store air, so that air passes through the esophageal entrance, and pronunciation is completed by the coordinated action of inhalation and exhalation and the pressure in the lungs. Patients can also be helped to choose an artificial larynx or use pronunciation tools. Provide patients with more opportunities to exercise and enhance their confidence in communicating with others.

Psychological care

Due to the change of lifestyle and insufficient understanding of laryngeal cancer, patients after laryngeal cancer surgery often have a pessimistic, disappointed, irritable, and resentful mentality, and lose confidence in life. Some even have radical behaviors. Therefore, family members can provide psychological counseling in a timely manner according to the patient's psychological state and cultural level, do a good job of comforting and explaining, respect the patient, and meet the patient's reasonable requirements as much as possible. Teach patients some communication skills, such as writing, gestures, pictures, etc., to reduce the patient's psychological burden, eliminate the patient's nervous and fearful emotions, enhance the patient's sense of security, get rid of pessimistic emotions, and build confidence in overcoming the disease. At the same time, establish a social environment conducive to rehabilitation for patients, encourage patients to establish beliefs, use the pronunciation methods and pronunciation tools they have mastered to communicate, express ideas, and continuously improve the quality of life.

Guidance for disease observation: Whether the operation can completely remove the tumor tissue is determined by objective and subjective factors. Therefore, patients should learn to observe the development and changes of the disease dynamically, and strictly follow the prescribed time for reexamination, even if there is no change; and follow up regularly. Patients and their families can frequently check the local area and touch both sides of the neck. If a lump is found, they should go to the hospital for examination at any time to avoid losing the opportunity for treatment. If there is an unexplained persistent headache, difficulty in swallowing, or the original choking cough suddenly worsens, or the voice quality and volume of speaking change, they should go to the hospital for examination immediately so as to find the problem in time and take necessary treatment measures. With the joint efforts of patients and their families, it will no longer be a problem to improve the quality of life and prolong the survival time of patients with laryngeal cancer after surgery.