Effect of modified middle and upper approach for radical resection of thyroid carcinoma on neck and chest pain, cosmetic effect and postoperative quality of life in patients with early thyroid carcinoma / 中国医师进修杂志

ABSTRACT

Objective:To investigate the effect of modified middle and upper approach for radical resection of thyroid carcinoma on neck and chest pain, cosmetic effect and postoperative quality of life in patients with early thyroid carcinoma.Methods:Ninety-seven patients with early thyroid carcinoma in the Third Hospital of Qinhuangdao City, Hebei Province from January 2017 to January 2020 were selected. According to the random digits table method, the patients were divided into the control group (traditional lateral approach for radical resection of thyroid carcinoma, 48 cases) and the observation group (modified middle and upper approach radical resection of thyroid carcinoma, 49 cases). The operation condition (operation time, intraoperative blood loss, dissection number of lymph node, drainage time, drainage volume and hospitalization time) and operative complication were compared between 2 groups; the degrees of neck and chest pain 1 d, 3 d, 1 month and 3 months after surgery were evaluated by visual analogue score (VAS); the cosmetic effect of the incision 3 months after surgery was evaluated by Vancouver scar scale; the thyroid cancer-specific quality of life (THYCA-QoL) scale was used to assess the changes in the quality of life before surgery and 3, 6 months after surgery.Results:There were no statistical differences in the dissection number of lymph node, drainage volume and hospitalization time between 2 groups ( P>0.05); the operation time, intraoperative blood loss and drainage time in observation group were significantly lower than those in control group (116.57 ± 25.75) min vs. (129.87 ± 30.01) min, (31.25 ± 4.15) ml vs. (37.98 ± 6.34) ml and (2.57 ± 0.45) d vs. (3.32 ± 0.67) d, and there were statistical differences ( P<0.05 or <0.01). The total complication incidence in observation group was significantly lower than that in control group 8.16% (4/49) vs. 45.83% (22/48), and there was statistical difference ( χ2 = 15.324, P<0.01). Neck VAS 1 d, 3 d and 1 month after surgery and chest VAS 3 d and 1 month after surgery in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.01 or <0.05); there was no statistical difference in neck and chest VAS 3 months after surgery between 2 groups ( P>0.05). The Vancouver scar scale score 3 months after surgery in observation group was significantly lower than that in control group (6.15 ± 1.35) scores vs. (8.43 ± 2.17) scores, and there was statistical difference ( P<0.01). The THYCA-QoL score 3 and 6 months after surgery in observation group were significantly higher than that in control group (46.25 ± 9.87) scores vs. (40.14 ± 7.52) scores and (53.65 ± 15.14) scores vs. (46.58 ± 9.87) scores, and there was statistical difference ( P<0.01). Conclusions:Compared with the traditional lateral approach, the modified middle and upper approach radical resection of thyroid carcinoma in treatment of early thyroid carcinoma can shorten the operation time, reduce intraoperative blood loss, reduce the incidence of surgical complications and reduce early postoperative neck and chest pain. It has better cosmetic effects and improves the quality of life of the patients.