Application Of Trans-oral Vestibule Endoscopic Surgery In Treatment Of The Thyroid Cancer

Background:Thyroid is an important human organ that synthesizes,reserves and secretes thyroxine.The thyroid disease is a frequently-occurring and common disease,many require surgery,and among them,most young women suffer such disease.With the further development of medical technology,the diagnosis rate and survival rate of thyroid cancer have been significantly improved.The traditional thyroid surgery will leave an obvious scar on the neck,which would affect cosmetic.How to reduce the thyroid surgical incision or move the surgical incision to hidden place,the surgical scientists have made efforts for many years.The transoral endoscopic surgery to treat thyroid cancer has experienced progressive development.The gradual development of endoscopic technology has provided solid basis for the diagnosis and treatment of thyroid diseases based on surgery.According to analysis from deeper perspective,during treatment of patients with thyroid cancer,the thoroughness of lower bound lymph node dissection in central area has been doubted in the field.Since 1995,the foreign scholars have tried to explore approaches for transoral endoscopic thyroid surgery.Both Chinese and foreign scholars started to consider the feasibility to conduct thyroid surgery from another direction.Various scholars,such as Dionig,Benhidjeb and Wilhem,started to try transoral endoscopic thyroidectomy in animals and corpses.In-depth research on the transoral endoscopic surgery has provided theoretical basis for clinical selection of suitable thyroid tumor treatment and lymph node dissection surgical plan.In 2008,Witzel et al.[1]initially proposed the new approach ETS based on the concept of NOTES,i.e.,TOET(transoral endoscopic thyroidectomy).In 2009,Wilhelm et al.[2]reported clinical transoral endoscopic thyroid surgery for the first time.In 2009,Akihiro Nakajo et al.started to implement the trans-oral vestibule non-aerated endoscopic thyroid surgery[3]-In China,in 2011,Professor Wu Guoyang and Professor Wang Cunchuan successively conduced transoral and trans-oral vestibule endoscopic thyroid surgeries[4].Zhongshan Hospital,Xiamen University has started transoral endoscopic thyroidectomy since November,2011,it has also completed the trans-oral vestibule endoscopic thyroid surgery in recent years,and satisfactory treatment effects have been achieved.We selected thyroid cancer patients from January,2017 to December,2017 who had thyroidectomy surgeries to explore the feasibility,safety and effectiveness of trans-oral vestibule surgeries in treating thyroid cancer.Objective:Explore the feasibility,safety and effectiveness of trans-oral vestibule surgeries in treating thyroid cancer.Methods:Conduct retrospective analysis of the clinical cases of thyroid cancer patients who had thyroid resections from January,2017 to December,2017 in the General Surgery Department of Zhongshan Hospital,Xiamen University.Because most patients who have transoral surgeries are young women of 16-40 who have cosmetic requirements,we selected cases from the age group of 16-40,among whom,11 cases had trans-oral vestibule endoscopic surgeries,and 47 cases had traditional open thyroid surgeries.We compared the path,operative method,operation time,the size of dissected thyroid lump,lymph node resection,intraoperative bleeding and incision recovery,the cosmetic effects and postoperative complications of two surgery approaches.Results:(1)In both two control groups,the surgery success rates reached 100%.Compared with the traditional opening group,in the transoral endoscopic group,the intraoperative bleeding was significantly reduced,comparison of lymph node resection,results no statistical differenceo the incision recovery was great,the cosmetic effects were significantly improved,the neck did not have surgical scar after surgery,and the skin did not change,which could effectively prevent oral infection.However,the surgery took longer time,and the hospitalization expenses were higher.Postoperative complications:In the transoral endoscopic group,there was 0 case of postoperative bleeding,and in the open surgery group,there was 0 case of postoperative bleeding;in the transoral endoscopic group,there was 0 case of numbness of hand and foot,in the open surgeiy group,there was 1 case of numbness of hand and foot,and there were no other complications such as dysphagia and subcutaneous hydrops.Conclusion:Compared with the traditional thyroid surgery,the transoral endoscopic thyroid surgery can provide almost perfect cosmetic effects,and the surgery is safe with small wound and fast recovery,which is effective and reliable.It has outstanding performance in treating thyroid cancer,which is an ideal surgical approach to conduct thyroidectomy,the lymph node dissection the is as the same handred-percent and safe with the traditional thyroid surgery,it's worth clinical promotion and application.