Abstract：Objective: To investigate the efficacy and safety of endoscopic thyroidectomy (ETS) through submental vestibular combined approach for the treatment of papillary thyroid carcinoma (PTC) by analyzing perioperative stress response and postoperative complication rate. Methods: A total of 114 patients with PTC from the First Affiliated Hospital of Kunming Medical University from January 2020 to October 2023 were selected and randomly divided into two groups using a random number table method, with 57 cases in each group. The control group underwent ETS through the oral vestibular approach, while the observation group underwent ETS through the submental vestibular combined approach. Surgical-related indicators, postoperative pain levels, perioperative stress indicators, parathyroid hormone (PTH) and blood calcium levels, immune function indicators (CD3+, CD4+, CD8+, CD4+/CD8+), and postoperative complication rates were compared between the two groups. Results: The intraoperative blood loss, postoperative drainage volume, operation time, drainage tube placement, and hospitalization time in the observation group were (21.53±2.69) ml, (33.52±3.09) ml, (60.54±9.12) min, (2.74±0.89) d, and (4.67±1.25) d, respectively, which were all less than those in the control group (24.59±4.37) ml, (36.14±4.18) ml, (80.96±11.23) min, (3.32±1.04) d, and (6.49±1.37) d, with statistically significant differences (t=4.502, 3.805, 10.657, 3.199, 7.409, all P<0.05). The pain VAS scores of the observation group at 4 h, 12 h, 24 h, and 48 h after surgery were (2.11±0.65), (2.84±0.78), (2.34±0.78), and (1.34±0.40), respectively, which were lower than in the control group (2.63±0.80), (3.31±0.87), (2.89±0.82), and (1.92±0.58), respectively, with statistically significant differences (t=3.809, 3.037, 3.669, 6.215, all P<0.05). The NE levels in the observation group at 24 hours and 72 hours after surgery were (0.64±0.12) mmol/L and (0.41±0.07) mmol/L, respectively, which were lower than in the control group (0.72±0.15) mmol/L and (0.46±0.09) mmol/L, and Cor values of (76.92±12.33) μg/L and (52.12±5.27) μg/L, respectively, which were lower than in the control group (85.46±15.02) μg/L and (58.14±7.12) μg/L, with statistically significant differences (t=3.144, 3.311, 3.318, 5.131, all P<0.05). The PTH levels in the observation group were (4.65±1.08) pmol/L and (5.15±0.70) pmol/L at 24 h and 72 h after surgery, respectively, which were higher than in the control group (4.08±1.24) pmol/L and (4.81±0.82) pmol/L. The blood calcium levels were higher than in the control group (2.15±0.09) mmol/L and (2.22±0.07) mmol/L, which were higher than in the control group (2.04±0.12) mmol/L and (2.17±0.09) mmol/L, respectively. The differences were statistically significant (t=2.617, 2.381, 5.537, 3.311, all P<0.05). At 7 days and 1 month after surgery, the CD3+, CD4+, and CD4+/CD8+ in the observation group were (61.33±4.06)%, (68.74±4.27)%, (32.94±3.02)%, (43.98±2.27)%, (1.14±0.12), and (1.76±0.17), respectively, which were higher than in the control group (59.07±3.85)%, (63.24±3.89)%, (28.89±2.74)%, (36.72±2.05)%, (0.93±0.10), and (1.34±0.15), and the CD8+ were (29.01±2.45)%, (25.02±2.13)%, which were lower than in the control group (31.14±3.02)%, (27.46±2.77)%, with significant differences (t=3.050, 7.189, 7.498, 17.920, 4.135, 5.272, 10.150, 13.986, P<0.05). The incidence of postoperative complications in the observation group was 3.51%, which was lower than in the control group (15.79%) (χ2=4.930, P<0.05).Conclusion: The treatment of PTC with submental vestibular ETS can reduce inflammation, relieve pain and promote the recovery of immune function with less trauma, rapid postoperative recovery and fewer complications.
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2024, Vol. 30 
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