Application Of Transoral Endoscopic Thyroidectomy Vestibular Approach In Thyroid Papillary Microcarcinoma

Objective:To investigate the feasibility of transoral endoscopic thyroidectomy vestibular approach in the application of thyroid papillary microcarcinoma by the comparative study of oral approach and open approach.Methods:From September 2017 to September 2019,41 patients(observation group)received transoral endoscopic thyroidectomy vestibular approach and 53 patients(control group)received open thyroidectomy in Loudi Central Hospital were selected as research objects.The length of hospital stay,operation time,intraoperative blood loss,intraoperative lymph node dissection number,postoperative pain degree,postoperative drainage volume on the first day,postoperative complications,cosmetic satisfaction were compared between the two groups.All cases were followed up for an average of 6 months.Results:1.All patients were successfully operated,and no life-threatening complications such as massive hemorrhage occurred after operation.No patients undergoing transoral endoscopic thyroidectomy vestibular approach were converted to open surgery during operation.2.There was no statistical difference in the number of lymph node dissection(5.24±1.50 vs 5.58±1.43),visual analogue scale score(4.88±0.98 vs 4.64±0.96),drainage volume(12.98±2.16 vs12.47±1.78),length of hospital stay(4.51±0.75 vs 4.32±0.64)on the first day and recurrence rate(?~2=0.034,P=0.854)between the two groups.3.The operation time in the observation group(110.12±6.06) was longer than that in the control group(90.30±6.01),the difference was statistically significant(T=15.798,P=0.000);The amount of intraoperative hemorrhage in the control group(13.10±2.31)was more than that in the observation group(13.10±2.31),the difference was statistically significant(t=4.961,P=0.000).4.There were 4 complications in the observation group, including 1 case of recurrent laryngeal nerve temporary injury,1 case of parathyroid gland injury,1 case of postoperative infection and 1 case of mental nerve temporary injury,while there were 3 complications in the control group,including 1 case of recurrent laryngeal nerve temporary injury and 2 cases of parathyroid gland injury,but there was no statistically significant difference between the two groups(?~2=0.563,P=0.453).5.The postoperative cosmetic degree of the observation group was significantly higher than that of the control group.30 cases were very satisfied,10 cases were satisfied and 1 case was normal in the observation group,while 2 cases were very satisfied,8 cases were satisfied,23 cases were normal,18 cases were not satisfied,and 2cases were very dissatisfied in the control group,the difference was statistically significant(?~2=57.496,P=0.453).Conclusions:1.Transoral endoscopic thyroidectomy vestibular approach requires a long operation time,but the amount of bleeding is less.Compared with the traditional open approach,there is no obvious difference in other aspects,and it has a good surgical effect.2.Transoral endoscopic thyroidectomy vestibular approach is safe and feasible,and is recommended for patients,especially young women with high cosmetic requirements.