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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 investigate the application of video-mediastinoscopic biopsy and treatment for pleural effusion. Methods Thirty-two patients with pleural effusion received mediastinoscopic biopsy or treatment. The patients were maintained at a lateral decubitus. A 2 cm incision was made along the midaxillary line for introducing the mediastinoscope. The pleural fluid was drawn out and exploration with biopsy was conducted under mediastinoscope. For 25 patients with malignant hydrothorax, talcum powder was applied for pleurodesis. Results The operation time was 30~70 min (mean, 42 min). A confirmative diagnosis was obtained by video-mediastinoscopy in all the 32 patients, including adencarcinoma in 22 patients, poorly differentiated squamous cell carcinoma in 2, invasive thymoma in 1, tuberculosis in 5, and inflammation in 2. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusions Video-mediastinoscopy is one of effective methods for biopsy and treatment of pleural effusion.