The Application Of Endoscopic Transvestibular Approach In The Resection Of Benign Thyroid Masses

Objective: In combination with the current clinical reports of endoscopic thyroidectomy through the oral vestibular approach,through the analysis and comparison of the advantages and disadvantages of transvestibular thyroidectomy,endoscopic thyroidectomy through the thoracic and breast approach and conventional open thyroid surgery,to explore the clinical efficacy of transvestibular thyroidectomy.Methods: The clinical data of 60 patients who underwent benign thyroid mass surgery in hengyang regional hospital from June 2018 to August 2018 were retrospectively analyzed.First affiliated hospital and the university of south China,south China university affiliated hospital of nanhua through the mouth into the endoscopy surgery patients for 20 cases(group oral approach),in the same period in the first hospital affiliated to the south China university of line of 20 patients with conventional open surgery group(conventional open)line and breast into for 20 cases of patients during endoscopy surgery group(breast milk into the road).The operative time,intraoperative blood loss,length of hospital stay,postoperative pain score(VAS),total drainage volume,scar length,postoperative complications,incision satisfaction measurement and other evaluation indexes of the three groups were compared,and the clinical efficacy of endoscopic thyroidectomy via oral vestibular approach was observed.Results: 1.Postoperative complications: in the routine open group,there were 40.0%(8 cases),3 cases of temporary hypothyroidism,2 cases of temporary hand and foot numbness,1 case of temporary hoarseness,and 2 cases of subcutaneous petechiae.The thoracic and breast approach group was 15.0%(3 cases),including 1 case of temporary hypothyroidism,1 case of temporary hand and foot numbness,and 1 case of subcutaneous petechiae.The oral approach group was 15.00%(3 cases),including temporary hypothyroidism(1 case)and neck numbness(2 cases).Oral approach group and thoracic approach group were significantly lower than the conventional open group,with statistically significant differences(P < 0.05),and there was no significant difference between oral approach group and thoracic approach group(P > 0.05).2.24 hours of postoperative pain score(VAS): conventional open group was 5.7 + /-0.86,breast approach group was 3.9 + /-0.79,the mouth into the road group was 1.9 + /-0.64,oral approach and breast into the road group obviously lower than that of conventional open group,the difference was statistically significant(P < 0.05),in which the mouth into the road again below the breast in the group,the difference was statistically significant(P < 0.05).3.Length of stay(d): 5.85 1.04 in the routine open group,4.8 0.70 in the thoracic approach group,and 4.5 0.89 in the oral approach group.The length of stay in the oral approach group and the thoracic approach group was shorter than that in the routine open group,with statistically significant differences(P < 0.05).4.Intraoperative blood loss:(ml): 46.75 19.89 in the conventional open group,23.25 13.00 in the thoracic approach group,15.25 11.41 in the oral approach group,and significantly lower in the oral approach group and thoracic approach group than in the conventional open group Statistical significance(P < 0.05),there was no significant difference between the thoracic approach group and the oral approach group(P > 0.05).5.Total wound drainage volume(ml): 62.50 15.17 in the conventional open group,40.50 9.98 in the thoracic approach group,and 26.70 22.67 in the oral approach group.Both the oral approach group and the thoracic approach group were significantly lower than the conventional open group(P<0.05),and the oral approach group was significantly lower than the thoracic approach group(P<0.05).6.Operation time(min): the routine open group was 60.4 26.67,the thoracic approach group was 121 33.11,and the oral approach group was 166 70.96.The operation time of the oral approach group was significantly higher than that of the thoracic approach group and the routine open group(P < 0.05).7.Incision satisfaction(%): the satisfaction of the conventional open group was 60.0%,that of the thoracic approach group was 85.0%,and that of the oral approach group was 100.0%.The satisfaction of the oral approach group and the thoracic approach group was significantly higher than that of the conventional open group(P<0.05),and that of the oral approach group was higher than that of the thoracic approach group(P<0.05).8.Scar length(mm): 53.15 6.31 in the conventional open group,25.4 2.35 in the thoracic approach group,and no scar on the body surface in the oral approach group.Compared with the thoracic approach group and the conventional open group,the difference was statistically significant(P < 0.05).Conclusion: Endoscopic thyroidectomy via the oral vestibular approach is an effective and feasible endoscopic surgical method with the advantages of rapid postoperative recovery,less trauma,fewer complications and "no scar" on the body surface,although the operation time is long and the operation difficulty is increased.