Objective To compare the clinical effects of endoscopic thyroidectomy with different ap-proaches on patients with thyroid cancer.Methods A prospective study was conducted on 96 patients with thy-roid cancer who underwent complete endoscopic thyroidectomy(CET)by the same experienced surgical team in the Head and Neck Surgery Department of Shanxi Cancer Hospital from Jan.2020 to Jan.2023.The patients were randomly divided into a trans-subclavian approach group of 48 cases and a transoral vestibular access group of 48 cases using a random number table method.The trans-subclavian approach group underwent CET via the subclavi-an approach,while the transoral vestibular access group underwent CET via the oral vestibular approach.The surgi-cal and postoperative rehabilitation conditions,complications,and cosmetic satisfaction scores were compared be-tween the two groups.The immune indicators(T lymphocyte subsets(CD3+,CD4+),CD4+/CD8+),serum soluble in-terleukin 2 receptor(SIL-2R),tissue kallikrein 11(KLK11),midkine(MK)levels were measured before surgery.At 1 d,3 d,and 7 d postoperatively,neck function was assessed using the visual analog scale(VAS),neck injury index,and dysphagia index.Results The operation time of the transoral vestibular access group and the Trans-subclavian approach group were(117.58±10.87)min and(101.84±1 1.35)min,respectively(P＜0.001),and the hospitalization time was(4.31±0.86)d and(5.12±0.91)d,respectively(P＜0.001).The drainage volume was(65.13±12.49)mL and(78.65±15.32)mL,respectively(P＜0.001).At 1,3,and 7 days after surgery,the CD3+levels in the transoral vestibular access group and the trans-subclavian approach group were(41.53±3.86)％and(38.29±3.51)％,respectively(P＜0.001),(46.21±4.35)％and(42.81±4.06)％,respectively(P=0.001),and(48.23±4.47)％and(45.10±4.23)％,respectively(P＜0.001).The CD4+levels were(33.27±3.90)％and(30.18±3.45)％,respectively(P＜0.001),(36.28±4.15)％and(33.46±3.87)％,respectively(P=0.001),and(38.69±4.22)％and(35.17±4.10)％,respectively(P＜0.001).The CD4+/CD8+levels were(1.31±0.22)and(1.16±0.21),respectively(P=0.001),(1.40±0.23)and(1.20±0.22),respectively(P＜0.001),and(1.58±0.24)and(1.45±0.25),respectively(P=0.011).There was no significant difference in the levels of serum SIL-2R,KLK11,MK,VAS scores,cervical injury index,or swallowing dysfunction index between the transoral vestibular access group and the trans-subclavian approach group on postoperative day 1,3,and 7(P＞0.05).The incidence of complica-tions in the transoral vestibular access group and the trans-subclavian approach group was 8.33％(4/48)and 22.92％(11/48),respectively(P=0.049),and the cosmetic satisfaction rate was 95.83％(46/48)and 81.25％(39/48),respectively(P=0.025).Conclusions Both the transoral vestibular approach and the subclavian approach for CET treatment of thyroid cancer can cause damage to cervical function.The former can reduce immune function damage,help with early postoperative recovery,and improve safety and patient satisfaction with cosmetic appear-ance,but it can prolong the operation time.
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