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Objective To study the application of video-mediastinoscopy in the preoperative staging of lung cancer and the diagnosis and treatment of mediastinal tumors or malignant pleural effusion.Methods Video-mediastinoscopy was performed in 128 cases under general anesthesia and single lumen endotracheal intubation,including 48 cases of cervical mediastinoscopy,33 cases of parasternal mediastinoscopy,and 47 cases of intercostal mediastinoscopy.Results The diagnosis was clarified under video-mediastinoscopy in 125 cases,including 38 cases of adenocarcinoma,33 cases of metastatic squamous cell carcinoma,9 cases of tuberculosis,8 cases of lymph node inflammation,7 cases of small cell carcinoma,6 cases of squamous cell carcinoma of the thymus,5 cases of non-Hodgkin's lymphoma,4 cases of neuroblastoma,4 cases of thymoma,3 cases of pleural mesothelioma,2 cases of Hodgkin's lymphoma,2 cases of neurilemmoma,1 case of sarcoidosis,1 case of hyperplasia of thymus gland,1 case of carcinoid,and 1 case of primitive neuroectodermal tumor.In 1 case,the mediastinal lymph nodes were diagnosed as reactive hyperplasia by video-mediastinoscopy,and then were confirmed as squamous cell carcinoma by postoperative pathological examination.Two cases were confirmatively diagnosed as having lung cancer in the left inferior lobe by brochoscopy, and video-mediastinoscopy revealed the metastasis to right paratracheal lymph nodes.Complications included 1 case of pneumothorax,1 case of hemorrhage,2 cases of recurrent laryngeal nerve paralysis,and 2 cases of superficial incision infection. Conclusions Video-mediastinoscopy is not only an important examination for preoperative staging of lung cancer and diagnosis of mediastinal diseases,but also a surgical treatment for mediastinal tumors and malignant pleural effusion.
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Objective: To determine the value of intercostal video mediastinoscopy (VMS) in clinical application. Methods: The clinical data of 126 patients treated with intercostal VMS were summarized retrospectively. Of them, 8 patients with suspected malignant pleural effusion underwent intercostal VMS pleural biopsy and talc poudrage pleurodesis, 118 patients with palmar hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Results: Definitive pathologic diagnosis has been made through VMS pleural biopsy in pleural effusion group, and the efficiency of talc pleurodesis was 100%(8/8). In 118 patients with palmar hyperhidrosis, the symptom of hands sweating disappeared completely after operation. Both hands became dry with an increasing skin temperature of 1 5℃～3 0℃ immediately after operation. No recurrence was recorded during the follow up. No mortality and morbidity were reported in this group. Conclusion: Comparing with VATS, intercostal VMS is easier to operate and less invasive. It is an effective and alternative procedure in the treatment of malignant pleural effusion and palmar hyperhidrosis.
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Purpose:Discuss the clinicat value of video-mediastinoscopy in the diagnosis and treatment of intrathoracic diseases. Methods:From Oct.2002 to Jun.2003, 58 cases were examined and treated by video-mediastinoscopy. Of these patients,48 case were examined(the examination group) and 10 cases were treated(the treatment group). In the examination group, standard mediastinoscopy was applied in 40 cases, extended mediastinoscopy was applied in 8 cases. In the treatment group,9 cases of palmar hyperhidrosis were treated by thoracic sympathectomy,1 case of pericardial liparomphalus was resected. Results:In the examination group, 47 cases obtained definite pathological diagnoses, and 5 cases had complications. In the treatment group,no complications occurred. Conclusions:Video-mediastinoscopy is a valuable procedure to clarify diagnosis and to stage lung cancer, or in the diagnosis of mediastinal mass. It can also be used in the treatment of palmar hyperhidrosis, pericardial liparomphalus and pericardial cyst.
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1.0 cm) by radiographic examinations, video-mediastinoscopy showed positive results in 30 cases, and negative in 14 cases, in which the surgical exploration found no evidence of metastasis to mediastinal lymph nodes. No postoperative complications and mortality were observed. Conclusions Video-mediastinoscopy offers clear operation field, high resolution, convenient application, safety and reliability. We suggest that it be adopted as a routine method in the diagnosis of mediastinal tumor and the staging of lung cancer.
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Objective To explore the feasibility of thoracic sympathectomy under video mediastinoscopy (VM) for palmar hyperhidrosis. Methods Operations on 55 patients with palmar hyperhidrosis were performed under general anesthesia with double lumen endotracheal tube placement. The patients were maintained in the 30?～45? semi-sitting position, with abduction of both arms to 90?. The VM entered the thoracic cavity via the third intercostal space on the anterior axillary line. The T 2～T 4 sympathetic ganglions were resected by electrocautery. Results Hyperhidrosis disappeared postoperatively in all the cases. The temperature of patients' both hands increased by 1.5～3 ℃,with their both hands becoming dry and warm. The operation time was 20～40 min (mean, 30 min) and the hospital stay was 3～7 d (mean, 4 d). No severe complications occurred. Mild subcutaneous emphysema along with pneumothorax was found in 3 cases and compensatory hyperhidrosis in the trunk happened in 5 cases. Conclusions Thoracic sympathectomy under VM is less invasive and simpler than that under video-assisted thoracoscopic surgery (VATS) in the treatment of palmar hyperhidrosis, being a feasible alternative.