Diagnostic Value Of Video-Mediastinoscopy For The Thoracic Diseases

Objective: To assess the diagnostic value and learning curve of Vedio-mediastinoscopy(VMS)for the 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 A,B,C and D groups according to the order of operation,24 cases in each group.The learning curve of VMS was calculated according to the amount of bleeding,operation time,complications,postoperative hospital stay,etc.Results:A total of 111 patients underwent VMS,including 63 males and 48 females,with an median age of 59(24-94)years.There were 100 cases of general anesthesia,11 cases of local anesthesia.95 patients underwent operation through a neck incision,9 patients through a lateral intercostal incision,and 7 patients through parasternal incision.There were 96 cases with mediastinal lymph node lesions,8cases with benign / malignant pleural effusion,and 7 cases with mediastinal mass.The diagnosis rate of all cases was 96.4%.The incidence of surgical complications was9.0%,including 1 case of intraoperative bleeding from arteriae anonyma,transient laryngeal recurrent nerve palsy with hoarseness in 1 case,delayed healing of incision in 7 cases,and 1 case of postoperative death from massive hemoptysis in advanced lung cancer(0.9%).Among the 96 patients with mediastinal lymphadenopathy,4patients did not receive a definitive diagnosis,and the diagnosis rate was 95.8%.In terms of bleeding volume,group A(26.25±32.90)ml and group B(34.08±101.64)mlwere significantly more than group C(6.58±9.99)ml and group D(8.63±9.40)ml.The difference between the four groups was statistically significant(P=0.004).There was no significant difference in operative time,perioperative complications and postoperative hospital stay(P > 0.05).Among them,60 patients were for mediastinal staging of lung cancer,54 patients were 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 were all100% for mediastinal staging of lung cancer.Conclusion:VMS is safe,minimally invasive and reliable in staging of lung cancer and diagnosis of thoracic diseases.Its learning curve for mediastinal lymph node biopsy is about 24-48 cases.