| Background: Thyroid carcinoma is one of the most common endocrine carcinoma.The morbidity increased rapidly in 20 years,which took up the top place of head and neck neoplasm.Papillary thyroid carcinoma(PTC)is the most common type of differentiated thyroid cancer(DTC).Clinically,there are so many patients with lymph node metastasis in the early course of the disease.Although patients with PTC have good prognosis,it is related to recurrence rate significantly.Thyroid lobectomy or bilateral thyroidectomy with ipsilateral dubious neck lymph node dissection can reduce the recurrence rate obviously.Present the patients with lateral neck lymph node metastasis in PTC,Surgery of traditional multifunctional lateral neck dissection(TMLND),post-operative selective iodine-131 and thyroid hormone suppression are the most common methods for the clinical therapy of thyroid carcinoma.But complications were observed in most of postoperative patients,such as,the formation of postoperative lymphatic leakage leads to surgical cavity infection,paresthesia in surgical and peripheral area,extensive scars formed over the surgical incision sites and so on.In recent years,endoscopic technology has been developed rapidly,complete subthoracic thyroid surgery techniques such as transoral vestibular,transaxillary,and transthoracic breast surgery have gradually improved.Under conditions based on indications,the endoscopic technique is no longer limited to thyroid lobectomy and central lymph node dissection,Lymph node dissection in the metastatic area of PTC in the lateral neck can be performed even by video-assited endoscopic technique through suprasternal approach.Level Ⅱ lymph nodes and submental lymph nodes,central cervical lymph nodes can also be involved,or selective dissection of cervical lymph nodes can also be achieved by the endoscopic technique.Total thyroidectomy with lateral neck lymphadenectomy assisted by endoscope has the advantages of small trauma,well recovery and beautiful incision.At the same time,the amplification effect of endoscope can clearly detect the complicated neck region,not only be able to sweep precisely,hidden lymph nodes that are easily ignored macroscopically are found with as little destruction of tissues such as nerves,muscles,and blood vessels as possible.While achieving therapeutic efficacy,compared with conventional multifunctional neck dissection,video-assited multifunctional lateral neck dissection(VAMLND)reflects the significance of minimally invasive surgery.In summary,this study is under the condition of existing medical level,the incidence of postoperative complications,hospitalization cost,hospital stay,operation conditions and other indicators were mainly compared between video-assited cervical lymph node dissection through suprasternal approach and traditional open surgery,in order to provide reference for selecting different treatment methods for patients with different conditions.Objective: To study the incidence of postoperative complications and hospitalization of patients undergoing video-assited cervical lymph node dissection through suprasternal approach compared with traditional open surgery.So as to provide reference for the treatment,surgical methods and postoperative management of patients with lateral neck metastasis of papillary thyroid carcinoma under the premise of existing medical level.Methods: A total of 300 patients who underwent radical thyroidectomy for papillary thyroid carcinoma in the Department of Thyroid Surgery of the First Betnune Hospital of Jilin University and were treated with TMLND or VAMLND for the first time between June 1,2006 and December 31,2018 in the follow-up database were retrospectively analyzed(Postoperative pathology confirmed papillary thyroid carcinoma with metastasis of papillary thyroid carcinoma in at least one lateral cervical lymph node).The patients were divided into conventional group(n = 150)and endoscope group(n = 150),the length of operation,postoperative surgical cavity drainage time,length of hospital stay,hospital costs,and parathyroid hormone(PTH)before and after surgery were recorded.They were also followed up postoperatively,including thyroglobulin(TG)values,blood calcium levels(or whether accompanied by numbness of the hands and feet),and whether there was cervical skin paresthesia,hoarseness and drinking water choking cough,the follow-up time was 6 months.Data statistics and analysis were performed using SPSS Statistics25.0 software,measurement data were expressed as x ±s,and t-test was used for comparison,enumeration data were expressed as n(%),and chi-square test was used for comparison,P<0.05 was considered statistically significant.Results: A total of 346 patients who met the inclusion criteria were included,of which 307 were successfully followed up.Of these,152 were treated with VAMLND and the remaining 155 with TMLND.A total of 150 patients were selected from these patients to represent the endoscopic group and the traditional group for comparative analysis.The results showed that the incidence of neck and shoulder paresthesia,temporary recurrent laryngeal nerve injury,lymphatic leakage,and temporary hypocalcemia were lower after VAMLND than after TMLND,and the postoperative hospital stay and surgical cavity drainage time of patients were shorter than those of patients who underwent TMLND,however,the cost of hospitalization was more,and the operation time was more.Overall complication rate was higher in the conventional group than the endoscopic group,and there was no significant difference in the probability of permanent recurrent laryngeal nerve injury,permanent hypoparathyroidism and the recurrence rate of papillary thyroid carcinoma between the two groups. |
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