A Comparative Study Of Supraclavicular Oblique Incision And Traditional Low Collar Incision Approach In The Surgery Of Unilateral Thyroid Cancer

Objective:To study the feasibility,effectiveness and safety of the supraclavicular oblique incision via anterior sternocleidomastoid approach in unilateral papillary thyroid carcinoma surgery,and to compare it with the traditional low collar incision via linea alba cervicalis approach,and to further explore the differences in cosmetic satisfaction of the incision and discomfort of the anterior neck region.Methods:The patients hospitalized in the Department of Thyroid and Breast Surgery,Huaihe Hospital,Henan University from November 2020 to November 2021 were collected.Preoperative thyroid color Doppler ultrasound,neck CT,fine needle aspiration biopsy,and other methods were used to preliminarily diagnose unilateral papillary thyroid carcinoma(PTC),and intraoperative fast frozen pathology showed PTC.52 patients with supraclavicular oblique incision via anterior sternocleidomastoid approach were selected as the observation group,and 52 patients with traditional low collar incision via linea alba cervicalis approach were selected as the control group,all patients underwent affected side thyroid lobectomy + isthmectomy + ipsilateral central lymph node dissection.All operations were performed by the same surgeon.The patients were followed up for 3 months.The general clinical data,perioperative indicators,postoperative pain,cosmetic satisfaction,anterior neck discomfort,and postoperative complications were compared between the two groups.Outcome:1.General clinical data: There were no significant differences in age,gender,tumor location and tumor size between the two groups(p>0.05).2.Perioperative indexes: there were no significant differences in operation time,intraoperative blood loss,and central lymph node dissection between the two groups(p>0.05);The incision length in the observation group was shorter than that in the control group,and the difference was statistically significant(P<0.05);The total postoperative drainage and drainage days in the observation group were lower than those in the control group,and the differences were statistically significant(p<0.05).3.Postoperative pain degree:the NRS pain scores of the observation group were lower than those of the control group on the first day and the third day after surgery,and the difference was statistically significant(p < 0.05).4.Cosmetic satisfaction: the scores of Patient Scar Assessment questionnaire(PSAQ)in the observation group were lower than those in the control group at 1 month and 3 months after operation,and the cosmetic satisfaction was higher,the differences were statistically significant(p < 0.05).5.Discomfort in the anterior cervical area: 3 months after surgery,1 case of neck tightness in the observation group and 8 cases of neck tightness in the control group,the difference was statistically significant(p<0.05);1 case of swallowing discomfort in the observation group and 11 cases of swallowing discomfort in the control group,the difference was statistically significant(p<0.05);There were 3 cases of numbness and pinprick sensation in the observation group and 10 cases in the control group,and the difference was statistically significant(p<0.05).6.Postoperative complications: no superior laryngeal nerve injury,parathyroid gland injury,postoperative bleeding or hematoma occurred in both groups after surgery;There was 1 case of temporary recurrent laryngeal nerve injury in the observation group and 3 cases of temporary recurrent laryngeal nerve injury in the control group.The overall complication rate in the observation group was 1.92%,which was less than that of the control group by 5.77%,but the difference was not statistically significant(p >0.05).Conclusion:1.Compared with the traditional approach,the supraclavicular oblique incision via anterior sternocleidomastoid approach can achie ve the same therapeutic effect,and does not increase the intraoperative risk and postoperative comp lica tions,which is a sa fe,effective and feasible surgical approach;2.The supraclavicular oblique incision approach has less obvious scar,easier to hide,higher cosmetic satisfaction,lower incidence of neck d iscomfort,and higher quality of life,which is a valuable alternat ive surgical approach besides the traditional low collar incision through the cervical white line approach.