| Objective:To study the safety,efficacy,satisfaction of overall cosmetic results,postoperative complications,etc.of the treatment of thyroid micropapillary carcinoma by modified Miccoli and full-areola approach with complete laparoscopic surgery.Clinicians provide scientific and reasonable reference for the diagnosis and treatment of thyroid micropapillary carcinoma.Methods:The study included 95 patients who had undergone surgical treatment from 2015 to 2018 in Puwai six wards of Qilu Hospital of Shandong University and whose routine pathology report confirmed thyroid micropapillary carcinoma.Among them,47 patients underwent complete endoscopic thyroidectomy and 48 patients underwent modified Miccoli procedure.Statistics of the patient's intraoperative blood loss,intraoperative and postoperative complications,postoperative routine pathology report,postoperative neck drainage,postoperative days of extubation,length of hospital stay,patient's subjective experience,postoperative The data on the degree of satisfaction of the overall beauty and related analysis were used to evaluate the difference between the two aspects in various aspects.Results:(1)Operation:There was no significant difference in the size of tumor foci between the two groups.All patients underwent complete continuity of the recurrent laryngeal nerve or intraoperative nerve monitoring signals during surgery.The operation time was significantly different(57.50±10.36 min vs.162.23±31.45 min,P<0.05);intraoperative blood loss was significantly different(13.20±4.02 m]vs 23.30±6.72 ml,P<0.05).(2)Postoperative conditions:There was no significant difference in visual analogue scales(VAS)scores at 6 hours after operation and there were significant differences at 12 hours after operation.The Reflux Symptom Index(Reflux Symptom Index)was measured at 3 days after operation.(Table)No significant difference(23.20±7.21 vs.26.10±6.80,P>0.05);Postoperative drainage improved Miccoli group was significantly smaller than the complete laparoscopic group(46.79±22.15ml vs.118.47±37.04ml,P<0.05);extubation time was significantly different(3.31±0.49d vs 3.98±0.77d,p<0.05);postoperative hospital stay was significantly different(4.01±1.41d vs 5.30±1.22d,P<0.05);There was no significant difference in VHI(Voice Handicap Index)at 3 months postoperatively(21.60±4.39 vs 22.70±3.42,P>0.05);postoperative routine pathology reported no lymph node dissection.Significant differences(3.02±3.11 vs.3.32±3.19,p>0.05);no significant difference in the number of metastatic lymph nodes(0.54±1.13 vs.0.68± 1.55,p>0.05).Patient satisfaction scores had no significant difference between the two groups(3.71±0.46 vs 3.80±0.36,p>0.05).Conclusions:Both methods can complete unilateral lobe + isthmectomy + central lymph node dissection in the affected area.The incidence of injury to the recurrent laryngeal nerve and parathyroid gland during operation is relatively low and there is no statistical difference.There was no significant difference in the number of metastatic lymph nodes in the central region between the total number of lymph nodes removed during surgery and the number of metastasis-involved lymph nodes.Therefore,both of them can identify with the papillary thyroid microcarcinoma.It is an effective and safe method of thyroid surgery for medical treatment.Compared with the two,the improved Miccoli surgery requires less time,less intraoperative blood loss,lower postoperative pain VAS scores,less postoperative neck drainage,shorter extubation time,and shorter postoperative hospital stays,resulting in lower risk of complications.Therefore,the patient's trauma to the modified Miccoli surgery is small.The modified Miccol procedure reduces the anterior cervical incision to its limit.Although there are still scars after surgery,the scar will gradually fade with the passage of time,and with the use of freckle drugs and accessories such as necklaces can be worn on the neck,Covers scars and reaches the neck with no blemish.And there was no statistical difference in the degree of satisfaction with cosmetic surgery between the two groups of patients. |
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