Primary malignant melanoma: a rare cause of mediastinal mass

A case of primary malignant melanoma in the mediastinum presenting as recurrent laryngeal nerve palsy is reported. Tissue biopsy at mediastinotomy yielded a diagnosis of malignant melanoma. The mass was fixed to the left aspect of the trachea and to the upper border of the left main bronchus and could not be removed surgically. Further extensive clinical and radiological investigations revealed no evidence of tumor elsewhere in the body.     

纵隔镜手术在肺癌分期中的应用价值

目的:探讨纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值.方法:回顾性总结1999年11月至2003年7月69例经纵隔镜检查肺癌患者的临床资料,其中颈部纵隔镜手术57例,胸骨旁纵隔镜手术7例,颈部加胸骨旁纵隔镜手术5例.术前所有患者胸部CT均发现纵隔淋巴结肿大(最小直径大于1.0cm).结果:本组69例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者50例,未见纵隔淋巴结转移(阴性)者19例.阳性者放弃手术,予以化疗.阴性者中15例中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实14例纵隔淋巴结未见转移,1例隆突后淋巴结可见癌转移(纵隔镜检查假阴性).纵隔镜手术敏感性、特异性和准确性分别为98.0%、100%和98.5%.全组术后发生声音嘶哑1例,并发症发生率为1.4%(1/69).无围手术期死亡.结论:纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法.     

纵隔镜检查术在胸部疾病中的诊断价值(附127例临床分析)

共施行纵隔镜检查术１２７例，诊断符合率达８７％。纵隔镜检查术对某些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，尤其适合诊断不明之单纯纵隔淋巴结肿大者。对肺癌伴有纵隔淋巴结肿大或纵隔肿瘤者可选择应用     

纵隔镜在上腔静脉阻塞综合征诊断中的应用

目的探讨纵隔镜在上腔静脉阻塞综合征（SVCOS）病因诊断中应用的可行性和价值。方法12例上腔静脉阻塞综合征病人，男9例，女3例；年龄16，71岁，平均45．2岁。行颈部纵隔镜检（CM）7例，胸骨旁纵隔镜检（PSM）5例。结果11例获得病理学诊断，阳性率91．7％。其中原发肺癌8例，淋巴瘤3例，未能明确诊断1例；所有病例手术经过均顺利，无并发症和死亡；1例淋巴瘤术后症状加重，化疗后缓解。结论纵隔镜检查对于SVCOS病例同样安全可靠，可作为其他方法不能确诊病例的可靠检查方法。     

应用纵隔镜检查周围型T1N0M0非小细胞肺癌淋巴结转移的价值

目的探讨常规应用纵隔镜检查周围型T1N0M0非小细胞肺癌纵隔淋巴结转移情况。方法2000年10月～2005年5月,23例临床诊断为周围型T1N0M0非小细胞肺癌的患者接受经颈纵隔镜检查,其中3例再行右斜角肌淋巴结活检;纵隔镜检查N2者行新辅助化疗,N3者仅行放、化疗。结果纵隔镜检查共发现1例N2患者,1例N3患者,阳性率为8.7%(2/23);敏感度为66.7%,特异度为100.0%,准确率为95.7%。结论对周围型T1N0M0非小细胞肺癌患者术前常规行纵隔镜检查,有对侧纵隔淋巴结转移者可避免不必要的手术治疗。     

纵隔镜术的发展历史

纵隔镜仍是纵隔疾病诊断和治疗的重要手术方法之一,在其半个多世界的发展历程中经历了探索,成熟和提高三个阶段。我国的纵镜技术虽起步尚早,但由于历史的原因发展很慢,目前仍滞后于发达国家。     

纵隔镜检查与肺癌切除术的围手术期护理分析

回顾性分析61例非小细胞肺癌进行纵隔镜检和肺癌切除的囤手术期护理。总结出整个护理过程的护理要点。主要包括术前心理、合并症的护理和术后呼吸道、并发症的护理。提出纵隔镜检查和肺癌切除的囤手术期护理对于提高手术成功率，减少术后并发症有着重要意义。     

Video-mediastinoscopic resection of a long bronchial stump and reclosure of bronchial insufficiency after pneumonectomy

Bronchial stump insufficiency after pneumonectomy is a severe problem and there is still debate about the appropriate method (transthoracic or transsternal) for reclosure. Access through a sterile operative field for a successful redo-procedure seems to be important so an alternative to the open methods could be the video-mediastinoscopy as it allows approaching the bronchial stump via the mediastinum. Previously in 1996 Azorin performed the first mediastinoscopic reclosure by stapling an early insufficiency after left pneumonectomy. We report the first case to our knowledge of resection and reclosure in bronchial stump insufficiency via mediastinoscopy. An HIV-positive man presented with late bronchial stump insufficiency after left pneumonectomy for lung cancer. The cause was a long bronchial stump and there was no sign of tumour recurrence. Decision was made for a video-mediastinoscopy and resection and reclosure successfully performed by using an endostapler device. Postoperative bronchoscopy at six months revealed a well-healed stump and two years postoperatively the patient is doing well. The mediastinoscopic approach is a novel option in highly selected patients. It warrants minimal surgical trauma; however, one has to be prepared to convert to an open technique immediately.     

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases

Objective:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value.

Methods:

We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up.

Results:

We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases.

Conclusions:

The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.     

Mediastinoscopy-assisted esophagectomy for thoracic esophageal cancer after right thoracotomy for lung cancer: report of two cases

We herein report two cases of thoracic esophageal cancer operated on by mediastinoscopy-assisted esophagectomy (MAE) via the neck and the esophageal hiatus after right thoracotomy for primary lung cancer. Case 1 was a 78-year-old man who had undergone a lower lobectomy of the right lung 5 years earlier and had also undergone a pleuroparietopexy for postoperative chylothorax via right thoracotomy again. A squamous cell carcinoma of the middle thoracic esophagus was detected by endoscopy. Although radiotherapy was performed on the patient, the esophageal tumor was locally recurrent. Thus, MAE was performed because it would have been difficult to approach the esophageal tumor by right thoracotomy again, and the patient was successfully treated. Case 2 was a 71-year-old-man who had undergone an upper lobectomy of the right lung 5 years earlier. For a squamous cell carcinoma located between the middle and lower esophagus, MAE was performed. Metastatic lymph nodes surrounding the middle and lower thoracic esophagus were sufficiently dissected. Although esophageal cancer patients with metachronous lung cancer are rare, therapeutic issues for these patients remain. MAE via the neck and the esophageal hiatus for esophageal cancer patients who had previously undergone a lobectomy of the right lung may be considered a tool for surgical approach. Furthermore, MAE may be considered to be a salvage operation such as in case 1.