| Objective: to retrospectively analyze the clinical data of patients with papillary thyroid carcinoma undergoing central lymph node dissection with complete endoscopy and traditional open surgery in general surgery of Qingdao University affiliated Hospital.To explore the safety and feasibility of cervical central lymph node dissection under full endoscopy;whether it can achieve the effect of traditional open surgery,and to explore its clinical value in the surgical treatment of thyroid carcinoma.Methods: 100 cases of thyroid papillary carcinoma resection were collected from the Affiliated Hospital of Qingdao University from July 2015 to December 2017.48 cases of traditional open operation(control led group)were performed according to the wishes of the patients.Endoscopic surgery was performed in 52 cases(experimental group).We have collected the operation time of patients of the two groups,the amount of intraoperative bleeding,the number of postoperative hospitalization,and the retention time of the drainage tube,the number of lymph nodes removed during the surgery,the number of parathyroid cut by mistake,the incidence of postoperative short-term complications,the 24 hour postoperative pain score(VAS),the survey of satisfaction and the recurrence rate 3 months after the operation.All the indexes mentioned above were reviewed and analyzed.Results: the operation time: the length of the experimental group was 112.92±21.70 min,the controlled group was 84.88±21.78 min,after the two groups of data were compared and analyzed,it turns out that: P < 0.01.So the difference was statistically significant,indicating that the time consuming of the endoscopic group operation was obviously longer than that of the open group.The amount of intraoperative bleeding was 14.23 ±3.62 ml in the experimental group and 26.21 ±7.22 ml in the controlled group.The difference between the two groups was statistically significant(P < 0.01),which indicated that the intraoperative bleeding in the endoscopic group was significantly less than that in the open group.Postoperative hospitalization days: the hospitalization days of experimental group and controlled group were 4.00 ±0.93 days and 4.04 ±1.11 days respectively(P > 0.05).The difference was not statistically significant,indicating that the days of postoperative hospitalization in the endoscopic group were close to those of the open group.The recovery time of the two groups was basically the same.The indwelling time of drainage tube was 3.08 ±0.79 days in the experimental group and 2.92 ±0.92 days in the controlled group.There was no significant difference between the two groups(P > 0.05).The results showed that the time of drainage tube indwelling in the endoscopic group was similar to that in the controlled group,and therewas no significant difference between the two groups in postoperative wound exudation.The number of the lymph nodes dissected during operation: the number of the lymph nodes dissected during operation was 6.81 ±3.38 in the experimental group and 6.25±2.60 in the controlled group.There was no significant difference between the two groups(P > 0.05),indicating that the number of lymph nodes dissected in the experimental group was the same with that in the controlled group.There was no significant difference in the effect of the lymph node dissection between the two groups.Number of parathyroid glands cut by mistake: there were no cases of mistakenly dissected parathyroid glands in both experimental and controlled groups.Postoperative short-term complications: the incidence of postoperative hoarseness and transient hypocalcemia in the experimental group was of no statistic significance(P >0.05).There was no permanent injury in the two groups.There were no postoperative complications such as bleeding,wound infection,tracheoesophageal fistula and so on.The scoring of pain at 24 hours after operation was 4.30 ±1.32 in the experimental group and 7.75 ±1.15 in the controlled group(P < 0.05).The difference was statistically significant,indicating that the postoperative pain degree of the patients in the experimental group was significantly less than that in the control group.The scoring of pain 24 hours after the operation: it was 4.30 ±1.32 in the experimental group and 7.75 ±1.15 in the controlled group(P < 0.05).The difference was statistically significant,indicating that the postoperative pain degree of the patients in the experimental group was significantly less than that in the controlled group.Scoring of cosmetic effect three months after operation: the score of cosmetic effect was 8.70 ±0.97 in the experimental group and 3.45 ±1.62 in the controlled group.The difference between the two groups was statistically significant(P < 0.05),which indicated that the patients in the experimental group were more satisfied with the postoperative incision than those in the controlled group.Postoperative follow-up: during the follow-up period of 6 months to 23 months,there was no recurrence in our patients,indicating that the results of operation in both groups were up to expectations and did not recur in a limited time.Conclusion: compare the total endoscopic lymph node dissection in the central area of thyroid cancer with the traditional open operation.We found that there was no significant difference between the 2 group in the time of postoperative recovery,the time of drainage tube indwelling,the number of dissected central lymph nodes,the protection of parathyroid glands,and the incidence and recurrence rate of short-term postoperative complications.Although the operative time of the endoscopic group was obviously longer than that of the open operation,the control of the amount of blood loss,the degree of postoperative pain and the cosmetic effect of surgical incision scar were significantly better than those of traditional open operation.In general,the central lymph node dissection of thyroid carcinoma via sternomammary approach under full endoscopic approach was feasible.It has the advantages of reducing the amount of intraoperative bleeding,reducing the postoperative pain degree and better cosmetic effect,and are more likely to be favoured by patients.chest-breast approach with thyroid carcinoma and lymphnode dissection in the central region,and it can achieve better cosmetic results and is more likely to be favored by patients. |
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