ABSTRACT
Objective:
To explore the
clinical efficacy of
areola approach endoscopic
thyroidectomy (
AET) and gasless axillary approach endoscopic
thyroidectomy (GAET) in the
treatment of
papillary thyroid carcinoma (PTC)
patients.
Methods:
A total of 96 PTC
patients from the
Thyroid Surgery Department of Linyi People’s
Hospital from May. 2019 to May. 2022 were selected and randomly divided into 48
patients using a random number table
method. The
areola group received
AET, while the
armpit group received GAET. The surgical situation, postoperative recovery, relevant biochemical
indicators [
white blood cell count (WBC),
erythrocyte sedimentation rate (ESR),
C-reactive protein (CRP),
parathyroid hormone (PTH),
blood calcium] before and after
surgery,
postoperative pain level, discomfort level,
neck function, and
complications were compared between the two groups.
Results:
The
surgical time and extubation
time of the
armpit group were (125.71±15.73) minutes and (3.12±0.53) days, respectively, which were shorter than those of the
areola group (137.94±20.02) minutes and (3.48±0.46) days. The intraoperative
bleeding volume was (14.19±4.16) mL, which was less than that of the
areola group (22.65±7.39) mL, and the number of
lymph nodes cleaned was 5.06±1.02, which was more than that of the
areola group (4.23±1.14) ( P<0.05) ; there was no significant difference in postoperative
drainage volume and
hospital stay between the two groups ( P>0.05) ; Peripheral
blood WBC in the
armpit group on the 1st and 3rd day after
surgery [ (5.69±0.15) ×10 9/L, (5.52±0.14) ] ×10 9/L, ESR [ (8.21±0.55) mm/h, (7.64±0.60) mm/h], CRP [ (10.06±1.78) ng/L, (8.93±1.33) ng/L] were lower than those in the
areola group [ (5.83±0.21) ×10 9/L, (5.70±0.23) ×10 9/L, (8.87±0.74) mm/h, (8.19±0.68) mm/h, (12.45±1.90) ng/L, (10.45±1.50) ng/L] ( P<0.05). There was no significant difference in the levels of the above biochemical
indicators 5 days after
surgery ( P>0.05). There was no significant difference in peripheral
blood PTH and
calcium levels between the two groups on the 1st, 3rd, and 5th postoperative days ( P>0.05). The
pain level [ (3.25±0.32) scores, (2.53±0.27) scores, (1.82±0.22) scores] and discomfort level [ (6.85±0.71) scores, (5.24±0.66) scores, (3.51±0.57) scores] in the axillary group were lower than those in the
areola group [ (3.78±0.40) scores, (2.89±0.34) scores, (2.06±0.26) scores, (7.46±0.84) scores, (6.09±0.73) scores, (4.16±0.60) scores] on the 1st, 3rd, and 5th postoperative days ( P<0.05). The
neck flexion, lateral flexion, and extension
range of motion in the axillary group on the 3rd day after
surgery were (33.16±3.09) °, (27.63±2.57) °, and (30.44 2.73) °, respectively, which were greater than those in the
areola group[ (30.08±2.76) °, (25.14±2.30) °, and (27.98±2.54) °], and the
swallowing disorder index was (30.16±4.97) points lower than the (34.83±4.13) points in the
areola group ( P<0.05). The
incidence of
complications in the axillary group was 4.17% (2/48), lower than the 16.67% (8/48) in the
areola group.
Conclusion:
GAET
treatment for PTC
patients can improve the effect of
lymph node dissection, reduce the degree of surgical
trauma,
postoperative pain and discomfort, accelerate early postoperative recovery of
neck function, and reduce
complications.