Clinical Application Of Non Inflatable Complete Endoscopic Surgery For Differentiated Thyroid Cancer Through Subclavian Approach

Objective: Comparing the clinical data of non inflatable TET through subclavian approach and OT through traditional anterior cervical incision in the treatment of DTC explores the safety and feasibility of non inflatable TET through subclavian approach in the treatment of DTC.Methods: 65 cases of DTC who underwent surgery in the nail and breast ward of the First Affiliated Hospital of Bengbu Medical College from September 2019 to March2021 were analyzed retrospectively.Among them,30 patients underwent non inflatable TET via subclavian approach（endoscopic group）and 35 patients underwent traditional anterior cervical incision OT（open group）.The clinical data of the two groups were compared.Results:The operations of the two groups were successfully completed.,and the endoscopic group was not converted to open in operation.there were no irreversible complications in all patients after operation.In the general clinical data,there was no significant difference between the endoscopic group and the open group in terms of gender,tumor diameter,pathological type,benign or malignant thyroid lobes and surgical methods（P>0.05）.Age of two groups: The endoscopic group was（45.3 ± 9.3）years old and the open group was（54.6 ± 11.1）years old,the difference was statistically significant（P<0.05）.It shows that the patients in the endoscopic group are younger.In perioperative data,the total operation time was（126.1 ± 15.2）min in endoscopic group and（95.6 ± 10.1）min in open group;Intraoperative bleeding volume: the endoscopic group was（26.3 ± 7.8）ml and the open group was（35.5 ± 9.7）ml;On the first day after operation,the drainage volume was（158.6 ± 41.6）ml in endoscopic group and（119.3± 15.6）ml in open group;The differences of the above indexes were statistically significant（P<0.05）.It shows that the endoscopic group had longer operation time,more drainage on the first day after operation,but less intraoperative bleeding.The number of lymph node dissections was（4.9 ± 3.3）pieces in endoscopic group and（4.2± 2.9）pieces in open group;PTH on the first day after operation: endoscopic group was（20.9 ± 11.4）ng / L,open group was（15.8 ± 10.5）ng/L;Postoperative hospital stay:endoscopic group was（5.1 ± 1.2）days,open group was（4.8 ± 1.6）days;There was no significant difference in the above indexes（P >0.05）and the total incidence of complications between the two groups,indicating that the endoscopic group can reach the CND level of the open group,but does not increase the surgical complications and prolong the hospital stay.In the follow-up data,the neck VAS score of endoscopic group was（4.5 ± 0.7）points on the first day after operation.The neck VAS score of endoscopic group was（3.5 ± 1.2）points on the third day after operation.the neck VAS score of endoscopic group was（1.0 ± 0.3）points on the third month after operation.the neck VAS score of open group was（3.8±0.5）points on the first day after operation.The neck VAS score of open group was（2.8±0.8）points on the third day after operation.the neck VAS score of open group was（1.1±0.2）points on the third month after operation.There was significant difference in the neck VAS score between the two groups at 1 and 3days after operation（P<0.05）,but there was no significant difference at 3 months after operation（P>0.05）,indicating that the degree of pain at the operation site in the endoscopic group was higher than that in the open group at 3 days after operation,but there was no significant difference between the two groups at 3 months after operation.The cosmetic satisfaction of endoscopic group was higher than that of open group（P<0.05）.The patients in both groups were followed up for more than 6 months.Conclusion:1、In the treatment of early DTC with no lymphatic metastasis in the neck and tumor diameter ≤ 4cm before operation,non inflatable TET via subclavian approach can achieve the same safety and feasibility as the traditional anterior cervical incision OT,but the long-term surgical effect still needs further follow-up study.2、In the return visit of postoperative cosmetic satisfaction,the incision was transferred to the subclavian through subclavian approach without inflation TET,and the cosmetic effect was higher than that of traditional anterior cervical incision OT.3、In the treatment of DTC through subclavian approach,the number of lymph nodes in the central area,postoperative hospital stay,postoperative complications and longterm pain can reach the level of traditional anterior cervical incision OT,and has the advantage of less intraoperative bleeding.Its disadvantages are long operation time and large postoperative drainage.