Natural orifice transesophageal thoracoscopic surgery: A review of the current state

Since the concept of Natural Orifice Translumenal Endoscopic Surgery (NOTES) was introduced, it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications. The ability to perform conventional laparoscopic and thoracoscopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field. While intra-abdominal NOTES has rapidly transitioned from animal models to human trials, applying the NOTES concept to perform thoracic procedures has been slower to gain momentum. The goal of this review is to summarize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.     

经肋间电视纵隔镜手术701例临床分析

目的探讨经肋间电视纵隔镜手术在纵隔肿物、恶性胸腔积液和手汗症诊治中的应用。方法回顾性分析2001年11月至2007年6月我院收治的701例经肋间电视纵隔镜手术患者的临床资料。其中术前未获得明确病理诊断的纵隔肿物患者48例和恶性胸腔积液患者46例,经肋间电视纵隔镜手术行纵隔肿物或胸膜活检,39例行滑石粉胸膜固定术;手汗症患者607例,行双侧胸交感神经链切断术。结果本组无手术死亡和严重并发症。48例纵隔肿物、46例临床诊断恶性胸腔积液患者,经肋间电视纵隔镜手术全部获得明确病理诊断。39例恶性胸腔积液患者行滑石粉胸膜固定术,成功率100％。607例手汗症患者术后手汗症状均完全消失,手掌温度上升1．5～3．0℃,温暖干燥,随访尚无患者复发。结论经肋间单一切口电视纵隔镜手术对于纵隔肿物、恶性胸腔积液和手汗症是一种简便有效的诊治手段。     

Cervical Mediastinoscopy Versus Computed Tomography for Detecting Enlarged Mediastinal Lymph Nodes in Non-Cancerous Lung Diseases

Cervical mediastinoscopy (CM) is considered to be the gold standard for evaluating mediastinal lymph nodes. The aim of this study was to determine the diagnostic yield of computed tomography (CT) and CM for detecting enlarged mediastinal lymph nodes in non-malignant pulmonary diseases. We retrospectively investigated the correlation and differentiation between chest CT and CM findings in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), in 30 patients with granulomatous lung disease diagnosed by CM and isolated enlarged lymph nodes seen on CT scans. Biopsy tissues from the lymph nodes in stations right, 1, 2, 3, 4, and 7, were obtained for pathological examination. The 30 patients comprised 11 men (mean age 47.1 ± 18.4 years) and 19 women (mean age 44.2 ± 14.0 years). Radiological examination showed that the diagnostic value of stations 2 and 4 was particularly high. Thus, when CM is used for diagnostic purposes, the small lymph nodes in station 1, obtained by careful dissection of the higher mediastinal region, can be helpful. Generally, there is no absolute consistency between the findings of CM and CT. For this reason, obtaining samples from each station regardless of CT findings is recommended.     

颈入路电视纵隔镜在胸部疾病中的临床应用

目的 总结颈入路电视纵隔镜检查术在胸部疾病诊断中的应用体会.方法 17例均在全身麻醉下行颈入路完成,其中单纯纵隔结节或肿物需要明确诊断者13例,确诊为肺癌伴有纵隔淋巴结肿大需明确临床病理分期者4例.结果 17例经过纵隔镜手术的病例均成功取得需要检测的组织,活检成功率100%.最终病理结果包括结节病6例,肺癌纵隔淋巴结转移5例,结核3例,淋巴瘤2例,慢性淋巴结炎1例.结论 电视纵隔镜在纵隔不明原因肿物的诊断和肺癌术前准确分期的临床应用中是一种安全、有效的重要手段. Abstract： Objective To summarize the application of cervical mediastinoscopy in the diagnosis of thoracopathy. Methods Seventeen patients were treated with video-assisted mediastinoscopy through neck-way surgery, including 13 cases with sole mediastinal nodule or mass,of which the pathologic diagnosis was warranted;4 cases diagnosed as lung cancer with enlarged mediastinal lymph nodes,of which the clinical stage needed to be clarified. Results Tissue for detailed examination was obtained for all of the 17 cases underwent mediastinoscopy.The successful rate for biopsy was 100%.The final pathologic diagnosis were 6 cases of sarcoidosis, 5 cases of lymph node metastasis from lung cancer, 3 cases of tuberculosis, 2 cases of lymphoma, 1 cases of the chronic lymph node inflammation. Conclusions Video-assisted mediastinoscopy is safe and useful in diagnosing of sole mediastinal mass and clarifying the pathologic stage of patients with lung cancer.     

经颈部纵隔镜检查在胸部疾病诊断中的价值

目的探讨经颈部纵隔镜检查术在胸部疾病诊断中的价值。方法回顾性分析1990年1月-2008年9月施行281例经颈部纵隔镜检查术的临床资料。采用局部浸润麻醉或全身麻醉,经气管前间隙向下方探查气管周围肿物和淋巴结,并进行活检。结果268例获得明确病理诊断,确诊率95.4%（268/281）。术前诊断不明23例全部获得明确病理诊断,恶性肿瘤术前诊断病理符合率56.9%（41/72）,良性病变术前诊断病理符合率87.4%（104/119）。结论经颈部纵隔镜检查术对单独或伴有纵隔内肿块的胸部疾病是一种有效的检查方法,对于诊断不明的单纯纵隔淋巴结肿大者尤其适合,对肺癌伴有纵隔淋巴结肿大或纵隔肿瘤者可选择应用。     

电视纵隔镜联合CD4/CD8对纵隔结核和结节病的诊断价值

目的探讨电视纵隔镜联合检测CD4／CD8在纵隔结核病和结节病诊断中的应用价值。方法回顾性分析2003年2月至2005年9月我院单纯纵隔病灶诊断不明行电视纵隔镜检查患者90例,应用免疫组化法对病理证实为结节病、结核病或不典型肉芽肿的患者57例检测CD4／CD8的表达情况。结果纵隔病灶活检确诊为结节病37例,结核病14例,淋巴瘤15例,原因不明的纵隔转移癌18例,无干酪性坏死又无典型结节细胞的肉芽肿6例,疾病确诊率为93．3％（84／90）;结节病病灶中CD4为（65±13）％,CD8为（9．4±2．6）％,CD4／CD8为7．3±1．8;结核病病灶中CD4为（41±11）％,CD8为（11．8±3．4）％,CD4／CD8为3．6±1．1,结节病病灶中的CD4／CD8明显高于结核病病灶。如果将CD4／CD8〉5作为诊断结节病的标准,则诊断结节病的准确性、特异性和敏感性分别为90．2％、85．7％和91．9％。本组病例未发生手术并发症,无死亡病例。结论电视纵隔镜检查对诊断纵隔疑难病灶的准确率高,部分病例结合CD4／CD8比值对诊断结核病和结节病有一定价值。     

Use of mediastinoscopy for foreign body removal

Foreign body removal from the aerodigestive tract can be a challenging endeavor despite improvements in technology. Rigid bronchoscopy has been demonstrated to be a safe and effective means of airway foreign body removal with appropriate training and expertise. However, potential complications exist and include extraluminal impaction of a penetrating foreign body during removal. This report details such a complication and the first known use of mediastinoscopy to remove the impacted foreign body to avoid the need for thoracotomy.     

纵隔镜检查术165例临床分析

目的 探讨纵隔镜检查术在胸部疾病诊断及确定手术适应证中的价值。方法 对1979－2000年,有选择性地施行纵隔镜检查术的165例患者的临床资料进行回顾性分析。所有患者皆采用局部浸润麻醉（个别病例加用静脉基础麻醉）下,经气管前间隙向下方探查气管周围肿物和淋巴结,并进行活检。结果 有125例诊断符合（11例未能明确诊断和8例肺癌患者虽纵隔镜检查阴性但未经手术证实不计入）,21例诊断不符合。诊断符合率为85．6％（125／146）。其中20例纵隔淋巴结阳性的肺癌患者和7例经纵隔镜诊断恶性淋巴瘤者避免了开胸手术。结论 纵隔镜检查术,对累及纵隔淋巴结的疾病或紧邻纵隔的胸部疾病是一种有效的检查方法,对于诊断不明的单纯纵隔淋巴结肿大者尤其适合。对肺癌伴有纵隔淋巴结肿大或纵隔肿瘤者可选择应用。     

腹腔镜联合纵隔镜在食管癌根治术中的应用

目的:探讨腹腔镜联合纵隔镜在食管癌根治术中的应用价值。方法:运用超声刀和L igaSure行腹腔镜下游离胃术、腹腔镜联合纵隔镜经后纵隔食管癌切除、胃食管左颈吻合8例,其中食管中段癌3例、食管下段癌5例,TNM分期为T1~3N0~1M0。结果:全组无手术死亡,无中转开胸或开腹手术,术中无输血,手术时间180~220m in,平均200m in,术中出血量50~150m l,平均l00m l,纵隔淋巴结清扫0~8枚,平均3.2枚,腹部淋巴结清扫0~6枚,平均1.4枚,术后胃肠功能恢复时间3~4d,平均3.7d,术后住院时间10~19d,平均12d。结论:对于中下段无外侵(≤T3)的食管癌患者在腹腔镜联合纵隔镜下行食管癌根治术可以提高手术的安全性,缩短手术时间,减少术中出血,减轻手术创伤,具有良好的推广应用价值。