A Retrospective Comparative Study Of Endoscopic Thyroid Surgery And Open Thyroid Surgery

Objective : The clinical effects of areola approach endoscopic thyroidectomy(AET),transoral endoscopic thyroidectomy(TOETVA)and traditional open thyroid surgery(OTS)were compared and analyzed.To explore the safety,effectiveness and feasibility of endoscopic thyroidectomy(ET).Methods:A total of298 cases of thyroid tumor patients admitted to Hubei Provincial People’s Hospital and the Department of Thyroid Surgery of our hospital from January 2017 to October2019 were collected.Among them,there were 159 patients with benign thyroid tumor and 139 patients with malignant thyroid tumor.The differences of intraoperative blood loss,operative duration,incision drainage volume,postoperative extubation time,postoperative hospitalization time,hospitalization cost,surgical complications and patients’ satisfaction with beauty between benign thyroid tumor and malignant thyroid tumor patients were compared and analyzed.Results:(1)Surgical efficacy of159 patients with benign thyroid tumor: 89 patients underwent ET,including 61 patients with AET and 28 patients with TOETVA.The remaining 70 patients underwent OTS,and all patients successfully completed the operation,while there was no transfer to open surgery in the patients undergoing ET.Compared with AET group,TOETVA group and OTS group,there were no significant differences in intraoperative blood loss,postoperative drainage volume,days of extubation,postoperative hospital stay and pain degree(P > 0.05).The operation time of AET group and TOETVA group was longer than that of open group(P < 0.05),and the operation time of TOETVA group was longer than that of AET group(P < 0.05).The hospitalization cost of AET group and TOETVA group was significantly higher than that of OTS group.No serious complications occurred in the three groups,and there was no statistical significance in complications(P > 0.05).(2)Surgical effect of 139 patients with thyroid malignancy: 79 patients received ET,59 of whom received AET,and 20 of whom received TOETVA.The surgical process was smooth.OTS was performed in the other 60 patients,and the operation process was smooth.Compared with AET group,TOETVA group and OTS group,there were no significant differences in intraoperative blood loss,postoperative drainage volume,days of extubation,postoperative hospital stay and pain degree(P > 0.05).AET group and TOETVA group had longer operation time and higher hospitalization cost than OTS group(P < 0.05),and TOETVA group had longer operation time and higher hospitalization cost than AE group(P < 0.05).No serious complications occurred in the three groups,and there was no significant difference in complications(P > 0.05).In 298 cases of thyroid tumor patients,patients receiving AET and TOETVA had higher satisfaction with cosmetic effect than OTS.Conclusion:(1)For patients with thyroid tumor,AET,TOETVA and OTS showed no significant difference in the treatment effect,and AET and TOETVA did not increase the incidence of postoperative complications;(2)AET and TOET can achieve no scar on the neck,and the cosmetic effect of patients is better with the same clinical effect.(3)TOETVA belongs to Notes surgery,which can achieve complete scar-free body surface.Due to small operating space,the operation is more difficult,but it may be more thorough in lymph node dissection than AET.