Clinical Analysis of Therapeutic Video-mediastinoscopy for Thoracic Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Zhilong , WANG Lin , LI Jianxin , YOU Maoduan , XU Jianyang , SHI Xiaoyu.

Department of Thoracic Surgery，Zhongshan Hospital，Dalian University，Dalian 116001，P. R . China;

Corresponding author：

Keywords：

Video-mediastinoscopy; Pleural effusion; Hyperhidrosis; Esophageal carcinoma; Mediastinal　disease

DOI：

10.7507/1007-4848.20130096

Video：

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Objective To assess clinical outcomes of therapeutic video-mediastinoscopy （VMS）. Methods　Clinical data of 82 patients undergoing VMS in Zhongshan Hospital of Dalian University from December 2008 to October 2011 were retrospectively analyzed. Among them，24 patients received therapeutic VMS，including 18 men and 6 women with their median age of 56 （22-81） years. Three patients underwent operation through a neck incision，4 patients through　a parasternal incision，and 17 patients through a lateral intercostal incision. Five patients received local anesthesia and basal　anesthesia，and all the other patients received general anesthesia through single-lumen or double-lumen endotracheal intubation.　Results Twelve patients with pleural effusion underwent pleural or lung biopsy and talc pleurodesis. Pathology examination　showed malignant diseases in 11 patients and tuberculous pleural effusion in 1 patient. The median operation time was 35 （30-50） minutes，and postoperative hospital stay was 3-6 days. These patients were followed up for 1 month without recurrence　of pleural effusion. Ten patients with mediastinal mass received pathological diagnosis and complete mass resection with their median operation time of 55 （30-270） minutes and median hospital stay of 7 （5-40） days. Two patients with hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Their operation time was 60 minutes and 50 minutes respectively，and their hospital stay was 3 days. Postoperatively their sweating symptoms obviously resolved. They were followed up for 3 months，and their hands，feet and armpit were warm and dry. There was no in-hospital death in this group. Two patients （8.3%） had postoperative complications including 1 patient with phrenic nerve injury and another patient with pneumonia. Opioid analgesic drugs were not used postoperatively in 9 patients. Conclusion Therapeutic VMS is a safe，effective，minimally invasive and cosmetic procedure，but it is not suitable for resection of a large mediastinal mass.

Citation： ZHAO Zhilong,WANG Lin,LI Jianxin,YOU Maoduan,XU Jianyang,SHI Xiaoyu.. Clinical Analysis of Therapeutic Video-mediastinoscopy for Thoracic Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 320-324. doi: 10.7507/1007-4848.20130096 Copy

1.	Harken DE， Black H， Clauss R， et al. A simple cervicomediastinal exploration for tissue diagnosis of intrathoracic disease; with comments　on the recognition of inoperable carcinoma of the lung. N Engl J Med，1954， 251 （26）：1041-1044.
2.	Carlens E. Mediastinoscopy：a method for inspection and tissue　biopsy in the superior mediastinum. Dis Chest， 1959， 36：343-352.
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7.	Atkinson JL， Fode-Thomas NC， Fealey RD， et al. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis：outcomes and complications during a 10-year period. Mayo Clin Proc， 2011， 86 （8）：721-729.
8.	Little AG. Video-assisted thoracic surgery sympathectomy for hyperhidrosis. Arch Surg， 2004， 139：586-589.
9.	Ishy A， de Campos JR， Wolosker N， et al. Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy：T3 and T4. Interact Cardiovasc Thorac Surg， 2011， 12 （4）：545-548.
10.	杨劫，谭家驹，王俊，等. 经肋间电视纵隔镜手术701例临床分析. 中华外科杂志， 2007， 45 （22）：1524-1526.
11.	Li X， Tu YR， Lin M， et al. Minimizing endoscopic thoracic sympa-　thectomy for primary palmar hyperhidrosis：guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg， 2009， 87 （2）：427-431.
12.	涂远荣，杨劼，刘彦国. 中国手汗症微创治疗专家共识. 中华胸心血管外科杂志， 2011， 27：449-451.
13.	叶国麟，杨劼，古卫权，等. 电视纵隔镜在胸腔积液诊治中的应用. 中国微创外科杂志， 2007， 74 （5）：424-425.
14.	Buess G， Becker HD. Minimally invasive surgery in tumors of the esophagus. Langenbecks Arch Chir SupplⅡVerh Dtsch Ges Chir， 1990：1355-1360.
15.	徐正浪，谭黎杰，王群，等. 影像监视经纵隔镜食管癌切除术10例报道. 上海医科大学学报， 1999， 26：227-228.
16.	徐志飞，吴彬，仇明，等. 腔镜在食管癌根治术中的应用. 中华胸心血管外科杂志， 2006， 22：361-364.
17.	王中林，张蕾，陆一民，等. 电视纵隔镜手术治疗早期食管癌89例报道. 中国微创外科杂志， 2010， 10：262–263.
18.	Venissac N， Pop D， Mouroux J. Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc， 2009， 23 （11）：2466-2472.
19.	Mimatsu K， Oida T， Kawasaki A， et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal Cancer. Surg Laparosc Endosc Percutan Tech， 2009， 19 （1）：e17-e20.
20.	翁文俊，张石江，邵永丰，等. 非开胸食管内翻拔脱术治疗食管癌105例. 中国胸心血管外科临床杂志， 2013， 20 （1）：59-62.
21.	Rendina EA， Venuta F， De Giacomo T， et al. Biopsy of anterior mediastinal masses under local anesthesia. Ann Thorac Surg， 2002， 74 （5）：1720-1722.
22.	邵丰，苏宜江，许栋生，等. 电视纵隔镜手术诊治胸部疾病36例. 中国胸心血管外科临床杂志， 2009， 16 （1）：76-78.
23.	Molins L， Fibla JJ， Pérez J， et al. Outpatient thoracic surgical　programme in 300 patients：clinical results and economic impact. Eur J Cardiothorac Surg， 2006， 29 （3）：271-275.

1. 　Harken DE， Black H， Clauss R， et al. A simple cervicomediastinal exploration for tissue diagnosis of intrathoracic disease; with comments　on the recognition of inoperable carcinoma of the lung. N Engl J Med，1954， 251 （26）：1041-1044.
2. 　Carlens E. Mediastinoscopy：a method for inspection and tissue　biopsy in the superior mediastinum. Dis Chest， 1959， 36：343-352.
3. 　王俊. 纵隔镜术的发展史. 中华医史杂志， 2001， 31：221-223.
4. 　Atkins JL， Butler PE. Hyperhidrosis：a review of current management.　Plast Reconstr Surg， 2002， 110 （1）：222-228.
5. 　Cerfolio RJ， De Campos JR， Bryant AS， et al. The Society of Thoracic　Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg， 2011， 91 （5）：1642-1648.
6. 　Krasna MJ. The role of surgical treatment of hyperhidrosis. Mayo Clin Proc， 2011， 86 （8）：717-718.
7. 　Atkinson JL， Fode-Thomas NC， Fealey RD， et al. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis：outcomes and complications during a 10-year period. Mayo Clin Proc， 2011， 86 （8）：721-729.
8. 　Little AG. Video-assisted thoracic surgery sympathectomy for hyperhidrosis. Arch Surg， 2004， 139：586-589.
9. 　Ishy A， de Campos JR， Wolosker N， et al. Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy：T3 and T4. Interact Cardiovasc Thorac Surg， 2011， 12 （4）：545-548.
10. 　杨劫，谭家驹，王俊，等. 经肋间电视纵隔镜手术701例临床分析. 中华外科杂志， 2007， 45 （22）：1524-1526.
11. 　Li X， Tu YR， Lin M， et al. Minimizing endoscopic thoracic sympa-　thectomy for primary palmar hyperhidrosis：guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg， 2009， 87 （2）：427-431.
12. 　涂远荣，杨劼，刘彦国. 中国手汗症微创治疗专家共识. 中华胸心血管外科杂志， 2011， 27：449-451.
13. 　叶国麟，杨劼，古卫权，等. 电视纵隔镜在胸腔积液诊治中的应用. 中国微创外科杂志， 2007， 74 （5）：424-425.
14. 　Buess G， Becker HD. Minimally invasive surgery in tumors of the esophagus. Langenbecks Arch Chir SupplⅡVerh Dtsch Ges Chir， 1990：1355-1360.
15. 　徐正浪，谭黎杰，王群，等. 影像监视经纵隔镜食管癌切除术10例报道. 上海医科大学学报， 1999， 26：227-228.
16. 　徐志飞，吴彬，仇明，等. 腔镜在食管癌根治术中的应用. 中华胸心血管外科杂志， 2006， 22：361-364.
17. 　王中林，张蕾，陆一民，等. 电视纵隔镜手术治疗早期食管癌89例报道. 中国微创外科杂志， 2010， 10：262–263.
18. 　Venissac N， Pop D， Mouroux J. Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc， 2009， 23 （11）：2466-2472.
19. 　Mimatsu K， Oida T， Kawasaki A， et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal Cancer. Surg Laparosc Endosc Percutan Tech， 2009， 19 （1）：e17-e20.
20. 　翁文俊，张石江，邵永丰，等. 非开胸食管内翻拔脱术治疗食管癌105例. 中国胸心血管外科临床杂志， 2013， 20 （1）：59-62.
21. 　Rendina EA， Venuta F， De Giacomo T， et al. Biopsy of anterior mediastinal masses under local anesthesia. Ann Thorac Surg， 2002， 74 （5）：1720-1722.
22. 　邵丰，苏宜江，许栋生，等. 电视纵隔镜手术诊治胸部疾病36例. 中国胸心血管外科临床杂志， 2009， 16 （1）：76-78.
23. 　Molins L， Fibla JJ， Pérez J， et al. Outpatient thoracic surgical　programme in 300 patients：clinical results and economic impact. Eur J Cardiothorac Surg， 2006， 29 （3）：271-275.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Therapeutic Video-mediastinoscopy for Thoracic Disease

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