| Differentiated thyroid carcinoma(DTC),including papillary thyroid carcinoma(PTC) and follicular thyroid carcinoma (FTC), makes up about 80 ~ 90 percent of all thyroid carcinoma. DTC occurs more often in youth women and grows slowly. The patients with DTC have a long-term survival and a favourable prognosis.DTC is not sensitive to radiotherapy and chemotherapy,surgical resection is the most effective treatment for DTC. Different pathological type of DTC have different biological behavior, the patients with DTC have different age, gender and TNM stage.Therefore,in the management of DTC, controversy exists not only about thyroidectomy but also about the extent of lymph node excision. The key to all successful surgery is adequate exposure, this is especially true during thyroid surgery. An incision should provide optimal exposure of the thyroid gland and also give a good cosmetic result.The incisions of DTC have Kocher incision,L-shaped incision, a parallel superior incision, X-shaped incision, Y-shaped incision, single-arm arc incision, etc. These incisions have adequate exposure of lesions and ensure radical neck dissection of DTC. But they are made too cephalad,they are quite noticeable when wearing normal clothing and increase chance of keloid scar formation, lower the life quality of patients with DTC. The purpose of this retrospective study was to investigate the optimal incision in radical operation of DTC by analyzing the clinical effect of long low collar incision and L-shaped incision, they were applied in radical operation of 84 patients with DTC.Materials and Metheds: Long low collar incision was applied in radical operation of 42 patients with DTC. 11 were male and 31 were female.Their ages ranged from 14 to 66 years with a mean of 39.74 ± 13.52. 37 were PTC,4 were FTC and 1 was mixed carcinorna(PTC ± FTC). According to the classification for malignant tumors of the UICC,14 were I stage, 15 were II stage, 13 were III stage.L-shaped incision was applied in radical operation of 42 patients with DTC. 10 were male and 32 were female. Their ages ranged from 20 to 66 years with a mean of 39.36±11.92. 38 were PTC,3 were FTC and 1 was mixed carcinoma(PTC-f FTC). According to the classification for malignant tumors of the UICC,15 were I stage, 16 were II stage, 11 were III stage.This paper reported the observation results of two groups in (l)total hospitalized days (2)postoperative hospitalized days(3)operative times(4) the blood transfusion,etc.Statistical analysis was done using the Statistical Package for the Social Sciences software(SPSS Statistical Software,Chicago,USA).There is a statistical significance when P<0.05.Results:(l)Both long low collar incision and L-shaped incision were applied in radical operation of 84 patients with DTC were no operational mortality and complications of skin flap necrosis,edema and dysfunction of upper limbs. (2)The total hospitalized days of long low collar incision group and L-shaped incision group were 16.60± 3.40 days(ranged from 8 to 24 days) and 17.5513.57 days (ranged from 10 to 27 days) .There was no significant difference between them(P>0.05). (3}The postoperative hospitalized days of long low collar incision group and L-shaped incision group were 5.36 ±1.48 days (ranged from 3 to 9 days) and 8.29± 1.90 days(ranged from 4 to14 days). There was significant difference between them (P<0.001). (4)The operative times of long low collar incision group and L-shaped incision group were 220.31± 41.12 minutes (ranged from 120 to 320 minutes) and 249.21±46.83 minutes(ranged from 140 to 370 minutes). There was significant difference between them(JP<0.01). (5)The blood transfusion:? patients in long low collar incision group and 27 patients in L-shaped incision group were accepted the blood transfusion(16.67% versus 64.29%). There was significant difference between them(P< 0.001). (6)Follow-up:the follow-up rate of long low collar incision group was 95.23%(40/42). Its 5 and 10 year survival rates were 100%(28/28) and 100%(12/12), respectively. |
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