The Advance In Mediastinoscopy And The Establishment Of Perioperative Management Protocol

Background and Objective:Since the first Standard cervical mediastinoscopy (SCM) performed and named by Carlens in 1959, we have seen great advancement in this area throughout the world. However, mediastinoscopy has not been given sufficient attention in China, and we are behind those developed western countries both in quality and quantity of the operations. The main purpose of this paper is to discuss the development of mediastinoscopy in our hospital as well as the establishment of conventional perioperative management in thoracic surgery of our hospital and point out the security,indications, contraindications of Mediastinoscopy. And hopefully through further understanding of this type of operations, we can go forward in the development of mediastinoscopy.Objects and Methods:The development of mediastinoscopy in our hospital was divided into two stages: the initial stage (early 1980s to December 1996) and the advance stage (January 1997 to February 2009). A comparison of the two stages in terms of the equipment, indication and operation skills has been conducted. Meanwhile, through the analysis of the contrast between the initial stage and the advancing stage in terms of the operation time,blood loss,postoperative hospital stay,average annual volume of surgery,perioperative management, I put forward the guideline of perioperative management for the patients in mediastinoscopy.Results:During the advance stage of mediastinoscopy development, we have not only improve d the precision of equipment and the skill of operation, but also expanded the indications for surgery and increased the safety of operation. Additionally, clinical principles of mediastinoscopy, such as indications, contraindications, equipment preparation, anesthesia, patient posture, operation procedures, preoperative and postoperative care, treatment and prevention of perioperative complications, were also established. This study showed that, in surgery patients of two stages , operation time and hospital stay waere significantly shorter , blood loss and postoperative complications were significantly reduced , surgical volume was markedly increased.Conclusion:Mediastinoscopy is not a simple and easy procedure, which requires many hours of clinical trial. Only by doing so, can we set a standard for mediastinoscopy, and further understand the reasons for perioperative complications, how to deal with such and preventing them from happening. In order to reduce the incidence of complications, it is necessary to familiarize ourselves with the anatomy of mediastinum and improvement of our operation skills. In conclusion, mediastinoscopy is a safe, reliable and effective procedure worthy of further promotion.