| Objective:Comparing the submental vestibular approach and the total vestibular approach by the propensity score matching method in the application of unilateral transoral endoscopic thyroidectomy plus central lymph node dissection for patients with papillary thyroid cancer,and evaluating the clinical vaule of the submental vestibular approach.Methods:This study retrospectively analyzed the cases of transoral thyroid surgery performed by the General Surgery Department of Zhongshan Hospital,Xiamen University from November 2020 to October 2021.The cases were screened according to the inclusion and exclusion criteria.There were 20 cases of unilateral transoral endoscopic thyroidectomy puls central lymph node dissection via the submental vestibular approach,and 71 cases of unilateral transoral endoscopic thyroidectomy puls central lymph node dissection via thr total vestibular approach,were included.The baseline data of the two groups of patients(age,gender,body mass index,tumor diameter,tumor location,thyroid function)were used as covariates to match the two groups of data with a 1:4 propensity score.The number of matched cases were 14 cases of the submental vestibular approach,and 41 cases of the total vestibular approach.Collect medical records and compare the differences of operation time,intraoperative blood loss,postoperative drainage volume on the first day,total postoperative drainage volume,postoperative hospital day,complications and follow-up data between the two groups after matching.Results:1.The results of propensity score matching showed that there was no significant difference in baseline data between the two groups.2.Perioperative clinical data:The operations of the submental vestibular group and the total vestibular group were successfully completed under endoscopy.The operation time of the submental vestibule group was significantly shorter than that of the total vestibule group(116.36±12.31 vs 132.17±42.27;P=0.041),and the difference was statistically significant.The intraoperative blood loss of the two groups was(9.64±6.03 vs 8.41±3.05;P=0.939),drainage on the first after surgery(86.79±31.48 vs 92.07±31.48;P=0.617),total postoperative drainage(155.57±60.05 vs 151.83±47.30;P=0.589),and postoperative hospital day(4.07±1.21 vs 3.44±0.55;P=0.082)of the two groups were no significant difference.3.Complications:one patient in the submental vestibular group developed transient vocal cord paralysis after surgery,while there was no temporary vocal cord paralysis in the total vestibular group(7.1%vs 0%;P=0.255),and the difference was not statistically significant;14 patients in the submental vestibule group had no obvious numbness of the mandibular skin in the observation trocar distribution area after the operation,while 41 cases in the total vestibular group had obvious numbness of the mandibular skin in the observation trocar distribution area after the operation(0%vs 100%;P=0.000),and the difference is statistically significant;the two groups of patients had temporary skin numbness in the operation trocar distribution area,and the difference is not statistically significant;there were no complications such as CO2 gas embolism,pleural injury,postoperative bleeding,permanent vocal cord paralysis,temporary hypoparathyroidism,permanent hypoparathyroidism,postoperative neck infection,and chyle leakage of the two groups.4.Postoperative pathology:postoperative pathology in the submental vestibular group showed 12 cases of papillary thyroid microcarcinoma,2 cases of papillary thyroid carcinoma,while total vestibular group had 35 cases of papillary thyroid microcarcinoma and 6 cases of papillary thyroid carcinoma,and there was no significant statistical difference between the two groups;there was no significant statistical difference in the number of lymph node dissections in the central compartment(6.64±2.95 vs 7.80±4.24;P=0.348)and the number of positive lymph node metastases in the central compartment(0.93±1.21 vs 1.05±1.47;P=0.999).5.Follow-up:The median follow-up time of 14 patients in the submental vestibular group was 13 months,and the median follow-up time of 41 patients in the total vestibular group was 6 months.The two groups of patients were satisfied with the cosmetic effect of the surgery.there was no tumor recurrence or distant metastasis in the two groups.Conclusions:In patients with papillary thyroid cancer undergoing unilateral transoral endoscopic thyroidectomy plus central lymph node dissection,there is no significant difference in central lymph node dissection efficiency and postoperative cosmetic effects between the submental vestibular approach and the total vestibular approach.The submental vestibular approach is safe and feasible,and it has a shorter operation time and does not cause long-term numbness of the mandibular skin in the distribution area of the observation Trocar after surgery,when ompared with the total vestibular approach;it is worth to be popularized. |
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