Diagnostic value of video-mediastinoscopy for thoracic diseases

doi:10.3877/cma.j.issn.2095-8773.2018.04.04

Abstract

Abstract:

Objective

To investigate the diagnostic value and learning curve of video-mediastinoscopy(VMS) for thoracic diseases.

Methods

Clinical data of 111 patients undergoing VMS in the same operative group in the department of thoracic surgery from January 2009 to June 2018 were retrospectively analyzed. Among them, 96 patients with mediastinal lymphadenopathy were divided into groups A, B, C and D according to the sequence of operation, 24 in each group. The learning curve of VMS was calculated according to the amount of bleeding, operative time, perioperative morbidities, postoperative hospital stay, etc.

Results

Among 111 cases of VMS, only 4 cases of mediastinal lymphadenopathy were not diagnosed clearly after operation, and the diagnostic rate of VMS was 96.4% (107/111). 8 cases of pleural effusion and 7 cases of mediastinal tumors were definitely diagnosed.The overall incidence of surgical complications was 9.0%, including 1 case of intraoperative bleeding from arteriae anonyma, 1 case of transient recurrent laryngeal nerve paralysis, 7 cases of delayed healing of incision, and 1 case of postoperative death from massive hemoptysis due to advanced lung cancer (0.9%). After mediastinal staging in 60 patients with lung cancer, 54 patients found mediastinal lymph node metastasis, and 6 negative patients were confirmed by radical resection. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VMS were all 100% for mediastinal staging in lung cancer. In terms of bleeding volume, group A (26.3±32.9) ml and group B (34.1±101.6) ml were significantly more than group C (6.6±10.0) ml and group D (8.6±9.4) ml. The differences between the four groups were statistically significant (P=0.004). However, there was no significant difference in operative time, perioperative morbidities and postoperative hospital stay(P>0.05).

Conclusions

VMS is safe, minimally invasive and reliable in staging lung cancer and diagnosis of thoracic diseases. Its learning curve for mediastinal lymph node biopsy is about 24-48 cases for clinicians.

Key words: Video-mediastinoscope, Thoracic diseases, Mediastinal lymph node, Learning curve

Yingding Ruan, Jianxing Li, Maoduan You, Hongsheng Xue, Jianyang Xu, Zhilong Zhao. Diagnostic value of video-mediastinoscopy for thoracic diseases[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(04): 219-224.

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References 27

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一般资料		n(%)
性别		?
?	男性	63(56.8)
?	女性	48(43.2)
吸烟史		?
?	否	69(62.2)
?	是	42(37.8)
麻醉方式		?
?	全身麻醉	100(90.1)
?	局部麻醉	11(9.9)
通气方式		?
?	气管插管	100(90.1)
?	面罩	11(9.9)
手术入路		?
?	颈部切口	95(85.6)
?	胸骨旁	7(6.3)
?	胸外侧肋间切口	9(8.1)
手术并发症		?
?	无	101(91.0)
?	有	10(9.0)

一般资料		n(%)
性别		?
?	男性	63(56.8)
?	女性	48(43.2)
吸烟史		?
?	否	69(62.2)
?	是	42(37.8)
麻醉方式		?
?	全身麻醉	100(90.1)
?	局部麻醉	11(9.9)
通气方式		?
?	气管插管	100(90.1)
?	面罩	11(9.9)
手术入路		?
?	颈部切口	95(85.6)
?	胸骨旁	7(6.3)
?	胸外侧肋间切口	9(8.1)
手术并发症		?
?	无	101(91.0)
?	有	10(9.0)

病理资料		n(%)
恶性淋巴结肿大(n＝62)		?
?	肺腺癌	19
?	小细胞肺癌	22
?	肺鳞癌	10
?	低分化肺癌	2
?	肺癌未分型	1
?	恶性淋巴瘤	5
?	乳腺癌	1
?	结肠癌	1
?	肾癌	1
良性纵隔淋巴结肿大(n＝7)		?
?	结节病	15
?	淋巴结增生	14
?	结核	4
?	肉芽肿性炎	1
纵隔肿物(n＝34)		?
?	纵隔囊肿	5
?	胸腺癌	1
?	异位甲状腺肿	1
胸腔积液(n＝8)		?
?	恶性	6
?	良性	2

病理资料		n(%)
恶性淋巴结肿大(n＝62)		?
?	肺腺癌	19
?	小细胞肺癌	22
?	肺鳞癌	10
?	低分化肺癌	2
?	肺癌未分型	1
?	恶性淋巴瘤	5
?	乳腺癌	1
?	结肠癌	1
?	肾癌	1
良性纵隔淋巴结肿大(n＝7)		?
?	结节病	15
?	淋巴结增生	14
?	结核	4
?	肉芽肿性炎	1
纵隔肿物(n＝34)		?
?	纵隔囊肿	5
?	胸腺癌	1
?	异位甲状腺肿	1
胸腔积液(n＝8)		?
?	恶性	6
?	良性	2

变量	A组(n＝24)	B组(n＝24)	C组(n＝24)	D组(n＝24)	统计量	P值
性别(男/女)	18/16	19/5	15/9	14/10	3.297	0.348
吸烟[n(%)]	9(37.5)	13(54.2)	11(45.9)	6(25)	4.621	0.202
年龄(±s，岁)	56.9±16.8	60.6±10.0	59.9±8.4	54.5±11.8	1.451	0.233
手术时间(±s，min)	109.8±39.2	97.1±44.0	96.9±52.2	88.2±32.5	1.053	0.373
术中出血量(ml)	10	5	5	5	13.532	0.004
术后住院时间(d)	3	3.5	4	3	2.244	0.523
术后并发症[n(%)]	1(4.2)	3(12.5)	4(16.7)	2(8.3)	2.197	0.684

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