| Research background and purpose:Thyroid cancer is the most common type of endocrine system malignant tumor in clinical practice,and its main pathological classification is divided into papillary carcinoma and follicular carcinoma.At present,the treatment of thyroid cancer is mainly treated by surgery,but because thyroid tumors are more common in young and middle-aged women,traditional neck surgery will leave a 6～8cm scar on the exposed area.For patients,especially female patients,it is easy to cause discomfort in life and psychology,making it difficult for patients to make decisions on whether to undergo surgical resection.Since 1996 and 1997,Gagner et al.and Hüscher et al.carried out the first parathyroid and thyroid laparoscopic surgery,with the continuous development of surgical technology and the improvement and innovation of surgical instruments,laparoscopic thyroid surgery has been rapidly developed,including external cervical approaches including through the armpit,breast,behind the ear,oral cavity,etc.In this study,laparoscopic surgery was used to treat thyroid malignant tumors,and the changes of thyroid-related indexes,the occurrence of complications,and the pain and aesthetic scores of patients after surgery were carefully observed,and their efficacy was evaluated,and the differences in efficacy of different laparoscopic surgeries were further analyzed,and whether different laparoscopic approaches became factors affecting the efficacy.This thesis aims to verify the efficacy,safety and specificity of laparoscopic axillary approach in the treatment of thyroid malignant tumors.This study will provide further clarification of the mechanism of action associated with this procedure and provide a theoretical basis for its clinical application.Materials and MethodsPatients who underwent thyroidoscopic(transthoracic approach group and transaxillary approach group)surgery from July 2020 to October 2022 were included.Before treatment,the number and size of tumors are routinely measured,and various data are recorded;Observe and record intraoperative data during treatment;Follow-up was followed for 3-6 months after treatment to observe and record the postoperative situation.The efficacy,safety and specificity of the study were evaluated by comparative analysis of the study indicators.Result The surgery was completed successfully in both the thoracic breast group and the axillary group,with no intermediate open cases.There was no statistically significant difference between the axillary group and the thoracic breast access group in terms of gender ratio,mass size and location,and age distribution between the two groups(p>0.05).Operative time:(150.3±28.1)min in the axillary group and(148.1±16.4)min in the thoracic breast group,with no significant difference between the two groups(P>0.05),indicating that the operative times were similar in the two groups.Separation flap and establishment of surgical space time:(58.7±13.9)min in the axillary group and(55.6±6.2)min in the thoracic breast group,with no statistically significant difference between the two groups(P>0.05),indicating that the separation flap and establishment of surgical space times were comparable in the two groups.Thyroidectomy time:(45.4±11.2)min in the axillary group and(48.7±9.2)min in the thoracic breast group,with no significant difference between the two groups(P>0.05),indicating that the surgical thyroidectomy time was similar in the two groups.Lymph node clearance time in the affected central region:(22.2±2.7)min in the axillary group and(22.2±3.2)min in the thoracic breast group,with a non-significant difference between the two groups(P>0.05),indicating that the lymph node clearance times in the two groups were similar.Comparison between axillary groups: operative time:(168.1±25.2)min in the first 20 groups and(128.1±9.6)min in the second 16 groups,a statistically significant comparison between the two groups(P<0.05),indicating that the operative time was longer in the former group than in the latter group.Time to separate the flap and establish the surgical space:(67.8±12.0)min in the former group and(47.3±4.3)min in the latter group,which was statistically significant(P<0.05),indicating that the time to separate the flap and establish the surgical space was longer in the former group than in the latter group.Thyroidectomy time:(51.3±11.4)min in the former group and(38.2±5.0)min in the latter group,which was statistically significant(P<0.05),indicating that the thyroidectomy time was longer in the former group than in the latter group.The lymph node clearance time in the affected central area was(22.7±3.0)min in the former group and(21.6±2.4)min in the latter group,which was not statistically significant(P>0.05),indicating that the lymph node clearance time in the two groups was comparable.The number of lymph nodes cleared in the central area of the affected side:(3.6±1.0)in the axillary group and(2.6±0.9)in the thoracic breast group,the P value was less than 0.05,indicating that the axillary group was better than the thoracic breast group in terms of the effect of lymph node clearance.The intraoperative bleeding volume was(13.1±8.1)ml in the axillary group and(10.9±7.6)ml in the breast group,with no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference(P>0.05)between the axillary group and the thoracic breast group in terms of relevant postoperative observations(including time indicators,drainage and complications,etc.).The VAS score on the third postoperative day was(2.8±1.1)in the axillary group and(5.4±1.1)in the thoracic breast group,with a significant difference between the two groups(P<0.05),indicating that the postoperative pain was less in the axillary group.A follow-up survey of cosmetic satisfaction between the axillary group and the breast and breast group was conducted 3 months after surgery,and the axillary group was significantly more satisfied than the breast and breast group(P<0.05),and the difference was statistically significant.Both groups were followed up for more than 3 months and no recurrence or metastasis occurred in any of the patients.Conclusions1.Transaxillary inflatable lumpectomy thyroidectomy has the same efficacy,safety and feasibility as trans-thoracic lumpectomy.2.The incision is located in the axilla,which is more concealed and provides better cosmetic results than the trans-thoracic lumpectomy.3.Axillary inflatable-free access lumpectomy thyroidectomy treatment is more thorough in clearing lymph nodes in the central region than trans-thoracic mammary approach lumpectomy treatment,with less postoperative pain and the incidence of postoperative complications,postoperative extubation and hospital stay are comparable to trans-thoracic mammary approach lumpectomy thyroidectomy.However,the transaxillary no-inflation approach has a unique learning curve related to its associated instrumentation hooks and anatomical site characteristics,with a cumulative total of approximately 20 cases required to master the procedure. |
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