Scientific name of basic introduction of western medicine: throat cancer: surgery-disease site: main symptoms of throat: main causes of pain and hoarseness: smoking and other groups of people: infectivity of all groups: whether they enter medical insurance: clinical manifestations, causes of disease, disease site, harm, metastasis and spread of throat cancer, disease treatment, treatment guidelines, treatment methods, surgical care, preoperative care, disease care, disease prognosis, diet conditioning, and so on. 2, abnormal laryngeal sensation-especially hypopharyngeal cancer often has unilateral laryngeal sensation abnormality. 3, pain-swallowing pain is not cured for a long time. 4, blood sputum-blood in the sputum when bleeding from the surface ulcer of laryngeal cancer. 5, swallowing difficulties-the continuous growth of hypopharyngeal tumors hinders the passage of food. 6. Dyspnea-airway obstruction when the laryngeal tumor is too large. 7, cervical lymph node enlargement-occurred in lymphatic metastasis. 8, others-such as Mo Ming's weight loss, loss of appetite. Pathogen 1, nicotine in tobacco, chemical carcinogen; Alcohol can be used as a solvent for carcinogens and promote carcinogens to enter the tongue mucosa. 2. Dentures, dentures, dental caries, incomplete dental ridges, etc. With inappropriate physical carcinogenic factors; Bad oral hygiene habits, long-term mechanical injury, often fishbone and bone spur. 3. Biological carcinogenic factors: human papillomavirus, heredity, individual susceptibility, nutritional metabolism disorder, race and radiation, etc. Location: 1, supraglottic type: including cancers above vocal cords, such as epiglottis, arytenoid fold, ventricular band, laryngeal cavity, etc. This kind of cancer is poorly differentiated and develops rapidly. Because of the abundant lymphatic vessels in this area, it is often easy to transfer to the lymph nodes located at the bifurcation of the common carotid artery in the upper cervical deep group. Early symptoms include foreign body sensation in the throat and pharyngeal discomfort. In the future, when the surface of the cancer festers, it will be stuck in the throat, which can reflect to the ear and even affect swallowing. After advanced cancer erodes blood vessels, there is blood in sputum, which often leads to phlegm odor; When it invades the vocal cords, it will cause hoarseness and difficulty breathing. 2. Glottic type: The cancer is confined to vocal cords, with anterior middle 1/3, which is well differentiated and belongs to grade I and II. The development is slow, and it is not easy to transfer to cervical lymph nodes because there are few lymphatic vessels in vocal cords. The main symptom is hoarseness, which is getting worse. When the tumor grows, it will block the glottis, which may lead to wheezing and dyspnea in the larynx, and blood sputum and laryngeal obstruction in the late stage. 3, subglottic type: that is, the cancer is located below the vocal cords and above the lower edge of cricoid cartilage. Because this area is hidden, routine laryngoscopy is not easy to find. There may be no symptoms in the early stage, and cough and blood sputum will appear in the later stage. In the late stage, because the subglottic area is blocked by cancer, it is often difficult to breathe. It can also penetrate the cricothyroid membrane, invade the thyroid and anterior soft tissue, and also infiltrate along the anterior wall of esophagus. 4. Paraglottic type: refers to cancer originating from laryngeal cavity, also known as penetrating glottic cancer. This area is very remote. It can be asymptomatic in the early stage and easily spread to the lateral space beside the glottis. Its clinical characteristics are: hoarseness as the first symptom, often fixed with recording tape first, but no tumor can be seen. Later, when the cancer spreads to the paraphglottic space, infiltrates and destroys the thyroid cartilage, it may cause sore throat. If the pterygoid plate and cricothyroid membrane of one side of thyroid cartilage are invaded, the thyroid cartilage scaffold can be felt on that side and there is a dry cough. The harm of laryngeal cancer is 1, and the voice is stubborn and hoarse: laryngeal cancer often involves vocal cords, even if it is very small, it will lead to hoarseness of patients. Hoarseness is the earliest sign of laryngeal cancer. Any adult with unexplained hoarseness for more than two weeks should have a careful throat examination and should not be taken lightly. 2. Laryngeal paresthesia: Foreign body sensation, sense of urgency or dysphagia are the early symptoms of supraglottic laryngeal cancer. However, the initial symptoms of this kind of cancer are often not obvious, and it was not discovered until the second and third stages. Therefore, middle-aged and elderly people should have a comprehensive and detailed examination if they have throat discomfort. 3. Cough with blood in sputum: Because the tumor can produce dry cough with blood in sputum, patients often feel sticky. After the tumor grows, it will block the airway, so that the tracheal secretions can not be discharged smoothly, causing respiratory infection, wheezing and even dyspnea. In the middle and late stage, it is characterized by persistent cough and pronunciation changes. 4. Reflex pain: When laryngeal cancer is complicated with ulcer, inflammation or thyrochondritis, it can cause nerve reflex pain, which is manifested as ipsilateral headache and earache. These symptoms mainly appear in patients with supraglottic tumors. 5. Presence of precancerous lesions: Some laryngeal diseases, such as laryngeal pachymosis, laryngeal mucosal leukoplakia, laryngeal tumors, etc., may also turn into cancer. This is called "precancerous lesion", so we must follow up regularly, just in case. Before being diagnosed, metastasis and diffusion usually develop into two areas. Diffuse and metastatic laryngeal cancer can spread and metastasize in the following three ways according to its differentiation degree and primary site: 1, direct diffusion: advanced laryngeal cancer often infiltrates and spreads to submucosa. Supraglottic carcinoma located in epiglottis can invade the anterior epiglottic space, epiglottic valley and tongue base. Arytenoid chondrocarcinoma in Daqing spread outward to pyriform fossa and lateral wall of larynx and pharynx. Glottic carcinoma can invade anterior commissure and spread to contralateral vocal cords; It can also destroy thyroid cartilage forward, enlarge the throat and infiltrate the soft tissue in front of the neck. Subglottic carcinoma spreads downward to trachea, or penetrates through cricothyroid membrane to anterior cervical muscle layer, develops to both sides and invades thyroid gland; The posterior part of the anterior wall of esophagus is involved. 2. Lymphatic metastasis: The metastatic site is mostly found in the lymph nodes at the bifurcation of the common carotid artery in the deep upper cervical group, and then develops along the internal jugular vein to the upper and lower lymph nodes. Subglottic carcinoma often metastasizes to qi and lymph nodes. 3. Vascular metastasis: it can be transferred to lung, liver, kidney, bone and pituitary gland. The most important principle of disease treatment is early diagnosis and early treatment. The first and second stage laryngeal cancer can be treated by radiotherapy or laser local resection, and the voice can still be produced naturally after operation. The third and fourth stages require extensive surgery or total laryngectomy, and the latter needs to speak with an artificial voice generator. The five-year survival rates from the first stage to the fourth stage are about 75%, 60%, 48% and 40% respectively. Because the early symptoms of pharyngeal cancer are not obvious, it is easy to delay early detection. When the larynx is invaded in the late stage, the larynx must be removed at the same time. In addition, there are abundant lymphatic vessels here, which are prone to neck or distant metastasis. The prognosis is worse than that of laryngeal cancer, and the five-year survival rate is about 15% to 30%. Treatment method 1. Radiotherapy is mainly suitable for stage I lesions: ① Small and superficial unilateral or bilateral vocal cord cancer, which has not invaded the anterior commissure, vocal cord process or subglottic area, and the vocal cord movement is good. ② Marginal carcinoma of epiglottis, the focus is less than 65438±0cm. (3) The general condition is poor and it is not suitable for operation. ④ Preoperative radiotherapy can give a variety of cancers involving throat delivery. The preoperative radiotherapy dose of 60 Co was 45-50Gy(4500-5000rad) within 4 weeks, and it was surgically removed within 2-4 weeks after radiotherapy. The dose of simple radiation is 60-70Gy(6000-7000 rads). 2. Vertical hemilaryngectomy is suitable for stage I vocal cord cancer. A slight incision was made at the midline of the healthy thyroid cartilage to remove the vocal cords and corresponding thyroid cartilage. But the pronunciation function is not as good as radiotherapy. 3. Horizontal hemilaryngectomy is suitable for supraglottic cancer, involving epiglottis, ventricular area, laryngeal cavity, arytenoid fold and other areas, but the vocal cords are still intact. The scope of surgical resection includes epiglottis, ventricular zone, laryngeal cavity, epiglottic anterior cavity or part of tongue root, transection of the upper part of thyroid cartilage, repair of laryngeal mucosa, preservation of vocal cords, and suture of tongue root with glottic region. If there is cervical lymph node metastasis, cervical lymph node dissection should be done at the same time. The function of larynx can be basically preserved after operation. 4. Total laryngectomy is suitable for stage Ⅲ and Ⅳ lesions: ① vocal cord cancer is extensive and vocal cord has been fixed; ② Vocal cord cancer has invaded the laryngeal cavity and ventricular area; ③ subglottic carcinoma; ④ Recurrence of laryngeal cancer after furuncle; ⑤ Laryngeal cancer has spread to the outside of the larynx, and thyroid cartilage destroys or invades the anterior epiglottic space, penetrates the cricothyroid membrane, and involves thyroid cartilage and other adjacent tissues. 5. New laryngeal reconstruction is a new surgical method developed in China in recent years. It is suitable for stage I and II laryngeal cancer, but not for radiotherapy alone and total laryngectomy is not needed. The principle of operation is to rebuild laryngeal function on the basis of radical cure of the disease. The main method is to keep the posterior 1/5 and the upper and lower corners of the affected thyroid cartilage plate, and the posterior 1/3 and the upper and lower corners of the contralateral thyroid cartilage plate as the posterior support for laryngeal reconstruction. Peel off and keep the perichondrium outside the thyroid cartilage plate, enter the laryngeal cavity under bright vision, and subtotally remove the laryngeal body along enough safe edges. Free hyoid bone, transfer its pedicle 90 degrees downward, and suture with the reserved cricoid cartilage or upper end of trachea as the front bracket of new larynx. The hyoid muscle membrane was transplanted to repair the mucosa of laryngeal cavity, and the water bag expanded the new laryngeal cavity After 3-4 weeks, the function of pronunciation and swallowing can basically be restored. 6. Trachelaryngectomy is suitable for subtotal laryngectomy with epiglottis preserved. The cervical trachea was separated to the plane of the fifth tracheal ring, and the lower edge of the pharyngeal orifice was sutured to the posterior wall of the tracheal orifice, so that the epiglottis was sutured to the anterior wall of 1 tracheal ring. The cervical trachea is used to replace the larynx. It is pulled up and fixed to the hyoid bone. After the operation, language can be pronounced. 7. Esophageal tracheostomy After total laryngectomy, a fistula was made between the posterior wall of tracheostomy and the anterior wall of esophagus, and the myocutaneous flap was sutured into a tube. After the operation, a silicone hose can be placed in this fistula to suck air into the pharyngeal cavity and esophageal cavity for pronunciation. 8. Laryngopharyngeal and upper esophageal colon replacement for esophagus is suitable for hypopharynx, pyriform fossa and cervical esophagus with tumor invasion. When pectoralis major muscle flap or neck flap can not be used for repair, free colon segment can be used to replace the resected defect area of throat and upper esophagus. 9. Laryngectomy plus neck lymph node dissection is an effective method to treat cervical lymph node metastasis of laryngeal cancer. If the patient's general condition can support it, we should strive for one-stage operation, that is, laryngectomy and neck lymph node dissection, including submandibular, submental, anterior, superficial and deep neck lymph nodes resection. Therefore, tissues including sternocleidomastoid muscle, scapulohyoid muscle, digastric muscle, internal jugular vein, accessory nerve and submandibular gland should be removed together with lymph nodes. 10, pronunciation training after total laryngectomy. Patients after total laryngectomy can practice using esophagus to store gas. Air passes through the entrance of esophagus, and the contraction of pharyngeal muscle replaces the vibration of vocal cords, which can produce pharyngeal esophageal sound. After patient training, they can gradually learn simple everyday language from numbers and words. If the pronunciation training of pharyngoesophageal sounds is ineffective, an electronic throat can be applied, placed on the side of the neck, and pronounced by an audio oscillator. After amplification, when the patient makes a simulated speech, he can make a speech. Audio can be adjusted, but the sound intensity is still not freely controlled, and there are often noises, which is still inconvenient to use. Surgical nursing preoperative nursing 1, total laryngectomy should do well the ideological work of patients and their families, explain the necessity of surgical treatment, and explain that patients can practice pronunciation or use artificial larynx after surgery to eliminate their concerns about surgery. If the patient is undergoing laryngoplasty, in order to promote wound healing, it is expected that the patient can't swallow and try not to talk after 1 week. 2. Patients with laryngeal cancer should prepare a pen and paper before operation, which is convenient for patients to express their postoperative needs. 3. On the 3rd day before operation, gargle with Dabbert solution or metronidazole injection, 4 times a day, and treat oral cavity and dental diseases at the same time. 4. Instruct patients with laryngeal cancer to take deep breaths and cough effectively, and advise smokers to quit smoking. 5, preoperative skin preparation site and scope should be accurate, be careful not to damage the skin. Disease nursing 1, laryngeal cancer patients should be cared by special personnel after general anesthesia, and the changes of patients' complexion, temperature, pulse, respiration and blood pressure should be closely observed. General anesthesia, after blood pressure is stable, give a semi-recumbent position. Laryngoplasty patients should lie flat and lean forward to reduce the tension of anastomosis. 2. Keep the respiratory tract unobstructed and suck out the secretions in the trachea at any time. Drugs such as morphine, codeine and atropine that inhibit respiratory and glandular secretion are prohibited. Strictly master aseptic technique to prevent tracheotomy anastomotic infection. 3. Inhale people through atomization, 3 times a day. When the sputum is sticky, Kangprotease can be dripped into the cannula to prevent the sputum from caking. 4. Keep your mouth clean and take oral care twice a day. Pay attention to observe whether there is exudate in the wound to prevent pharyngeal leakage. 5. After neck lymph node dissection, connect negative pressure drainage, keep the drainage tube unobstructed, and observe the color, quantity and nature of drainage fluid. 6, teach patients how to deal with casing. Patients undergoing total laryngectomy must wear a cannula 1 year to prevent narrow mouth. 7. The room temperature should be kept at about 20℃ and the relative humidity should be 60%. Keep the respiratory tract moist. 8, tracheotomy patients can't hold their breath, keep the stool unobstructed, prevent constipation. Avoid heavy physical labor and prevent colds. 9, high body temperature, close observation of body temperature changes, according to the doctor's advice to give physical cooling and daub drugs. 10, 2 weeks after operation, can help patients practice pronunciation, let patients swallow a certain amount of air and store it in the esophagus, and then slowly escape the sound. Based on the principle of easy before difficult, practice from single tone. 1 1. After hemilaryngectomy and before extubation, the tube is gradually blocked from half to full. After 1-2 days of observation, extubation can be performed without dyspnea. 12. Wash the inner cannula 1-2 times a day after operation to prevent phlegm epilepsy from blocking the respiratory tract. The wound dressing under the cannula should be changed/kloc-0 times a day. Tie the casing with knots to prevent the casing from falling off. If the patient is blue and emotional, it suggests the possibility of extubation, and report it to the doctor in time. Once the catheter falls off, immediately insert the forceps prepared by the bedside into the tracheostomy to keep the airway unobstructed, and then cooperate with the doctor to replace the tracheal intubation. 13. After the operation, it is forbidden to eat or drink by mouth. A nutritious liquid diet should be fed by nose, 200 ml each time, 4-5 times a day. After perfusion, 200-300mL warm water should be injected to keep enough moisture. At the same time, we should pay attention to supplement vitamins, vegetable juice and fruit juice. After hemilaryngectomy, gradually return to normal diet, and pay attention to whether the patient has choking cough and swallowing difficulty. Prognosis of the disease Among all cancers, the prognosis of laryngeal cancer is quite good, which can be regarded as a "curable cancer". And the earlier it is found and treated, the better the prognosis. Overall, the 5-year survival rate is over 70%, and the 10-year survival rate is about 50%. Dietary adjustment The prominent symptom of laryngeal cancer patients is dysphagia, which is also a serious problem in the diet of laryngeal cancer patients. Dysphagia in most patients with laryngeal cancer occurs gradually and gets worse gradually. At first, patients only felt a choking cough when eating dry food, which gradually worsened and even developed into soft food and semi-liquid food. In the end, it is completely difficult to drink water and eat, which makes the nutritional status of patients worse and worse, and finally leads to nausea. It can be seen that eating difficulty is a very serious problem for patients with laryngeal cancer. For patients with early and middle stage laryngeal cancer who have been diagnosed, we should seize the opportunity to increase nutrition in an all-round way, give patients soft food or semi-liquid food containing high protein and vitamins, make full use of the absorption function of their gastrointestinal tract, supplement nutrition as much as possible, and let patients have better physical condition. In order to make chemotherapy go smoothly, rich nutritious food should be combined with drug therapy to improve the tolerance of human body to the side effects of anticancer drugs. During chemotherapy, patients should have a high-calorie and high-protein diet, such as chicken, duck, fish, shrimp, lean meat and eggs, so as to play an auxiliary treatment role. Diet should be diversified, pay attention to diet collocation, in order to complement each other and improve the body's immunity. If you have five symptoms of upset, fever and yin deficiency, eat tremella porridge or soak it in American ginseng 0. 15g for tea. If economic conditions permit, you can stew turtle soup. Cooking pays attention to color, fragrance and taste, and it is best to steam, boil and stew. Do not eat or eat less smoked, fried and baked food, eat less pickled food, and smoke and drink less. Alcohol can activate a variety of carcinogens and reduce immune function. The staple food of chemotherapy patients can be steamed stuffed bun, jiaozi, wonton and noodles according to their eating habits and tastes. Patients with poor appetite can eat less and eat more. Different from other tumors, laryngeal cancer is not a bad appetite, but a difficulty in swallowing, which leads to physical exhaustion. Therefore, we should eat as much food as possible that can enter the esophagus, such as semi-liquid food and total liquid food, pay attention to the quality of semi-liquid food and total liquid food, do not limit calories, and be nutritious, soft and easy to digest and absorb. If necessary, we can make homogeneous meals, essence meals and mixed milk. Homogenated diet is a kind of diet which is made of normal human bones and then stirred into paste by high-speed tissue masher. The nutrients contained in it are similar to those in normal diet, but it is easy to digest and absorb after crushing in vitro, which can avoid long-term single diet and prevent constipation. Eat more anti-cancer food. It has been found that Cordyceps sinensis can effectively phagocytose tumor cells, the effect is four times that of selenium, and it can also enhance the adhesion of red blood cells to tumor cells, which can prevent tumor recurrence and metastasis during tumor chemotherapy and after tumor surgery. Formula; Choose Fulinmen Cordyceps sinensis with high content of natural cordycepin, take it after crushing, once 1.5g, twice a day, and take it continuously for one month. Most patients can get good curative effect. The main points to be avoided in the diet of patients with laryngeal cancer are: 1. When the patient has a choking feeling, don't swallow it forcibly, otherwise it will cause bleeding, spread, metastasis and pain of local cancer tissue. When suffocation is severe, you should take liquid food or semi-liquid food. 2. Avoid eating cold liquid food, and don't drink noodles, milk, egg soup, etc. It was relatively cold for a long time. Because the narrow part of the esophagus is very obvious to cold food, it is easy to cause esophageal spasm, nausea and vomiting, pain and numbness. So it is better to eat warm food. 3. Don't eat spicy, spicy, smelly and fishy food, because these foods can also cause esophageal spasm and make patients feel uncomfortable. For laryngeal cancer patients who can't eat at all, intravenous high nutrition should be used to maintain the needs of patients. Cancer can be divided into benign and malignant, and malignant tumor is also called cancer. The following dietotherapy drugs and medicated diet compounds have certain anticancer effects and can be taken according to the specific conditions of patients. 1) 60g of fresh straw mushroom and 60g of fresh Hericium erinaceus are cooked and sliced; Heat the cooking oil, add a little salt, add both, stir-fry and add water to cook. This prescription is mainly used for digestive tract tumors. 2) Boil 60g of Hericium erinaceus, 60g of Hedyotis diffusa and 60g of rattan pear root in Hericium erinaceus soup with water. Can be used for treating gastric cancer, esophageal cancer, cardiac cancer and liver cancer. 3) Coix seed water chestnut Scutellaria barbata soup 30g of Coix seed, 30g of water chestnut and 30g of Scutellaria barbata, decocted in water, 1, taken twice a day for a long time. Can be used for gastric cancer, cervical cancer, etc. 4) 20 grams of raw barley porridge, 30 grams of glutinous rice or japonica rice, and half a spoonful of sugar. Pour the coix seed and rice into a small steel pot, add about 1000 ml of cold water, cook for about half an hour on medium heat, and remove from the heat. 65438+ breakfast or snacks 0 times a day. Eating this porridge regularly is ideal for preventing gastric ulcer canceration; For patients with gastrointestinal cancer who have been surgically removed, eating it can also reduce the chance of recurrence. 5) 15g dry bamboo leaf tea, half a cup of boiling water, cover it, and you can drink it after five minutes. Indocalamus leaves contain polysaccharides, so they have a wide range of anti-cancer and detoxification effects. 6) Arnebia euchroma and mung bean soup: Arnebia euchroma 15g, mung bean 30g, sugar 1 spoon. Stir-fry Arnebia euchroma first, then stir-fry mung beans with Arnebia euchroma head juice, simmer for about 3 minutes, and wait until the mung beans bloom after leaving the fire. Filter out the soup, leaving mung beans and a little juice. Then pour the second Arnebia euchroma juice into the mung bean pot, burn the mung bean, and add water if the water is not enough. When the juice is about 500 ml, leave the fire. 7) Turtle Jieyu Decoction 1 Turtle, 9 grams of Bupleurum, 9 grams of peach kernel, 0/5 grams of Atractylodes macrocephala/KLOC-0, and 30 grams of Hedyotis diffusa. Wash the turtle, fry other medicines to remove residues, stew the turtle until it is cooked, and then eat the turtle soup. 1 dose 2-3 days, often taken. This prescription can be used as an adjuvant treatment prescription for nasopharyngeal carcinoma. 8) Appropriate amount of swim bladder, 3g of notoginseng powder and appropriate amount of yellow wine. The swim bladder is fried with fragrant oil and crushed into powder, 5g each time, and washed with yellow wine together with Tianqi. Every day 1 dose, take 15-20 doses continuously, for a total of 1 course of treatment. This prescription can be used for patients with esophageal cancer of blood stasis type.