Clinical Comparative Study Of Endoscopic Thyroidectomy Via The Chest And Breast Approach And Open Thyroidectomy

Objective Endoscopic thyroidectomy via the chest and breast approach is the most popular one in all of the endoscopic thyroidectomy(ET)recently,and it can bring better cosmetic results compared with open thyroidectomy(OT).So Endoscopic thyroidectomy via the chest and breast approach is called "cosmetic operation ".But,some one argue that ET hurts hugely and is not safety.Hear,we investigae the clinical effects between Endoscopic thyroidectomy via the chest and breast approach and open thyroidectomy.Methods One hundred and four patients with thyroid disease were chosen in the period from Jan.2015 to Mar.2016 and randomly divided into Group ET(n=50)with totally endoscopic resection and Group OT(n=54)with open resection,and the perioperative clinical indicators,cosmetic satisfaction after operation and complication incidence of both groups were compared.Results(1)General datas :Group ET 50,male 3,female 47;Group OT 54,male9,female 45;P=0.08.The mean age was [Group ET(49.58±8.86)years,Group OT(50.10±9.55)years,P=0.17].The mean tuber diameter was [Group ET(29.81±11.35)mm,Group OT(30.40±14.97)mm,P=0.27].There was no obvious difference between Group ET and Group OT,and they were comparable.(2)The datas of benign thyroidectomy :The mean operation time was[ Unilateral: Group ET(1.47±0.40)h,Group OT(1.18±0.44)h,P<0.05;Bilateral: Group ET(2.00±0.41)h,Group OT(1.33±0.30)h,P<0.05].The average intraoperative blood loss was [ Unilateral: Group ET(10.56±3.79)ml,Group OT(11.67±7.28)ml,P=0.57;Bilateral: Group ET(13.44±6.51)ml,Group OT(18.06±13.63)ml,P=0.21].The postoperative drainage volume in front of the neck was [ Unilateral: Group ET(9.72±7.17)ml,Group OT(12.61±8.25)ml,P=0.27;Bilateral: Group ET(12.44±7.27)ml,Group OT(25.67±26.29)ml,P=0.054].The extraction time of drainage in front of the neck was [ Unilateral: Group ET(2.28±0.57)d,Group OT(2.17±0.38)d,P=0.50;Bilateral: Group ET(2.13±0.50)d,Group OT(2.33±0.91)d,P=0.42].The mean hospitalization stay was [ Unilateral: Group ET(5.94±1.39)d,Group OT(6.17±1.58)d,P=0.66;Bilateral: Group ET(6.75±2.18)d,Group OT(6.33±1.50)d,P=0.52].(3)The intraoperative datas of differentiated thyroid cancer(DTC)resection :1.Bilateral totally thyroidectomy and unilateral the 6thlymph resection : Group ET6,Group OT 8,P=0.68;The mean operation time was [ Group ET(2.75±0.27)h,Group OT(1.81±0.37)h,P<0.05;].The average intraoperative blood loss was [ Group ET(16.67±5.16)ml,Group OT(13.75±5.18)ml,P=0.32].2.Bilateral nearly totally thyroidectomy and unilateral the 6thlymph resection : Group ET 7,Group OT 6,P=0.53;The mean operation time was [ Group ET(2.64±0.38)h,Group OT(1.92±0.20)h,P<0.05;].The average intraoperative blood loss was [ Group ET(18.57±6.90)ml,Group OT(13.33±5.16)ml,P=0.16].3.Unilateral totally thyroidectomy and unilateral the 6thlymph resection : Group ET 3,Group OT 4,P=0.80;The mean operation time was [ Group ET(2.33±0.29)h,Group OT(1.38±0.48)h,P<0.05;].The average intraoperative blood loss was [ Group ET(13.33±5.77)ml,Group OT(15.00±5.77)ml,P=0.72].(4)The postoperative datas of differentiated thyroid cancer resection : The postoperative drainage volume in front of the neck was [ Group ET(10.44±5.10)ml,Group OT(23.06±26.91)ml,P=0.067;].The extraction time of drainage in front of the neck was [ Group ET(3.13±2.13)d,Group OT(2.39±0.50)d,P=0.195].The mean hospitalization stay was [ Group ET(9.25±7.22)d,Group OT(5.94±1.51)d,P=0.067].The number of total lymph node harvested was [ Group ET(2.25±2.24),Group OT(3.00±3.36),P=0.455].The number of positive lymph node dissected was [Group ET(0.69±1.25),Group OT(0.33±0.84),P=0.335].(5)The comparision of complications after operation(the hoarseness of voice,the choke of drinking,numbness of limbs or mouth,aerodermectasia,seroma nd the discomfort of the neck):There was no the hoarseness of voice and the choke of drinking.Numbness of limbs or mouth:Group ET 8,Group OT 6,P=0.47;Aerodermectasia:Group ET 3,Group OT 0,P=0.07;Seroma:Group ET 2,Group OT0,P=0.14;The discomfort of the neck:Group ET 0,Group OT 6,P=0.02.Total complications :Group ET(14/50),Group OT(12/54),P=0.50.(6)The cosmetic results were [ satisfied: Group ET(48),Group OT(30);not satisfied: Group ET(2),Group OT(24);P<0.05].There was significant difference between Group ET and Group OT in the cosmetic results,and Group ET can bring a better cosmetic effect.Conclusion Endoscopic thyroidectomy via the chest and breast approach does not increase the neck cavity mirror physical trauma,to benign thyroid diseases and DTC diseases,but greatly reduce the patient’s psychological trauma,and the operation is safe and feasible.