Postoperative care after laryngeal cancer resection

What are the postoperative care for laryngeal cancer resection? The main symptoms of laryngeal cancer are hoarseness, dyspnea, cough, dysphagia, cervical lymph node metastasis, etc. The order of symptoms may be different in different primary sites. What are the postoperative care for laryngeal cancer resection?

Surgical care for patients with laryngeal cancer can be divided into the following aspects:

(1) Before total laryngectomy, the doctor should do a good job of ideological work with the patient and his family, explain the necessity of surgical treatment, and ask the patient (the patient who will be examined after surgery) to share his own experience, explaining that he can practice pronunciation or use an artificial larynx after surgery to solve the problem of postoperative language communication. This will eliminate the patient's concerns about the surgery. Instruct the patient not to swallow within one week after laryngectomy to promote wound healing, and ask the patient to prepare paper and pen or pictures, as well as gestures to express needs before the operation. Start gargling with Dobel solution 3 days before the operation, 4 times a day. If there is a dental disease, it should be treated.

(2) After the operation, the patient should be nursed according to general anesthesia and the changes in blood pressure, pulse, respiration and body temperature should be closely observed. After the patient wakes up from anesthesia and the blood pressure stabilizes, the patient should be placed in a semi-recumbent position. The patient undergoing laryngoplasty should lie flat with the head forward to reduce the tension on the anastomosis.

(3) Follow the tracheotomy care and perform aseptic operation techniques to prevent wound contamination, keep the airway open, aspirate tracheal secretions at any time, maintain the relative humidity of 50% to 60%, and, if necessary, use nebulizer inhalation 2 to 3 times a day, or add 1 to 2 drops of 1% sodium bicarbonate to the tracheal tube to reduce phlegm and prevent phlegm crust from blocking the tube and causing suffocation. For patients who have undergone partial laryngectomy, the laces must be tied tightly to prevent the tube from falling off and causing breathing difficulties for the patient. The tracheal tube should be cleaned four times a day.

(4) Observe the bleeding tendency. If the neck blood vessel ligature is found to be slipping or the innominate vein or artery is found to be ruptured and bleeding, apply pressure to the bleeding point immediately, report to the doctor immediately and actively cooperate with the rescue.

(5) After surgery, it is strictly forbidden to eat or drink anything. Do not swallow saliva. Keep the oral cavity clean. Starting from the third day after surgery, rinse the mouth frequently with Dobel solution or 1.5 ml hydrogen peroxide to promote wound healing. Pay attention to whether the wound has exudation and bleeding, pay attention to changes in body temperature, and prevent anastomotic fistula.

(6) Nasogastric feeding of mixed milk diet for 7-10 days, 4-5 times a day, 500 ml each time. After the infusion, inject 200-300 ml of warm water to maintain adequate water and prevent the stomach tube from being blocked or dislodged. When starting to eat, instruct the patient to chew slowly. Patients with partial laryngectomy should first eat sticky semi-fluid food to prevent it from entering the trachea and causing choking.

(7) After cervical lymph node dissection, when the drainage is connected to negative pressure suction, keep the drainage unobstructed to promote wound healing.

(8) Training esophageal pronunciation. After the wound heals, the patient should attend an esophageal pronunciation class. The patient can swallow a breath and store it in the esophagus, then slowly expel it and make a burp sound. Pay attention to the coordination of the abdominal and chest movements, esophageal burping movements, and mouth shape movements to make sounds. Regular training is sufficient to maintain daily life needs.

(9) Before discharge, patients should be taught how to suction sputum and use cannulas and laryngeal pads. Even patients who have undergone total laryngectomy should wear cannulas to prevent stenosis of the stoma (tracheostomy). Patients should also be advised to prevent constipation, maintain smooth bowel movements, avoid physical labor, take precautions against colds and flu, avoid catching cold, and come to the hospital for regular checkups.

(10) Patients who receive radiotherapy alone may suffer from breathing difficulties or even suffocation due to tumor compression or laryngeal edema. Therefore, emergency items such as tracheotomy trays, suction devices, and oxygen should be prepared at all times.