Mediastinoscopy

Mediastinoscopy is used for the staging of lung cancer, especially in patients with enlarged lymph nodes on chest X-ray or CT scans. Some doctors believe that all lung cancer patients should be invasive staging, while others believe that only for patients with abnormal lymph nodes found in imaging. Mediastinoscopy should be performed under general anesthesia in the operating room. The mediastinoscope enters through a concave incision in the sternum, accessing some of the carina and hilar lymph nodes, parabronchial and paratracheal lymph nodes, and the posterior superior mediastinum. Basic Information Specialist Category: Respiratory Examination Category: Endoscope Applicable gender: whether men and women apply fasting: fasting Tips: Pay attention to normal eating habits and pay attention to personal hygiene. Normal value There is no lump in the mediastinum. Clinical significance Mediastinoscopy can be used to diagnose mediastinal masses or to sample lymph nodes in patients with lymphoma or granulomatous lesions. Abnormal results: (1) staging of known or suspected lung cancer patients; (2) diagnosis of mediastinal and hilar space-occupying lesions and enlarged lymph nodes; (3) diagnosis of necrotizing or submucosal lesions (4) nodular lesions of the surrounding lung parenchyma; (5) upper sulcus tumors; (6) diagnosis and drainage of mediastinal benign cystic lesions (such as cysts and abscesses). The people who need to be examined have the above symptoms. Precautions Pay attention to normal eating habits before the examination, pay attention to personal hygiene. (1) The surgeon should be familiar with the comprehensive knowledge of mediastinal anatomy and be proficient in fiberoptic bronchoscopy; (2) routinely read the chest X-ray film and CT film before surgery to determine the location of the lesion and the larger lymph nodes adjacent to the trachea; Requirements for examination: The patient actively cooperates with the doctor. Inspection process Mediastinoscopy should be performed under general anesthesia in the operating room. The mediastinoscope enters through a concave incision in the sternum, accessing some of the carina and hilar lymph nodes, parabronchial and paratracheal lymph nodes, and the posterior superior mediastinum. Complication rate <1%, including bleeding, vocal cord paralysis caused by recurrent laryngeal nerve injury; chylothorax caused by thoracic duct injury. Operation process: 1) When the puncture needle is sent through the fiberoptic bronchial biopsy hole, the needle tip must be first retracted into the protective sheath. After the position is selected under direct vision and fixed, the needle tip is pushed out to prevent damage to the trachea and the fiber bronchoscope; 2) Pierce the lesion area as far as possible in the vertical direction, pay attention to avoid the bronchial and cartilage rings, and ensure the depth of the needle into the lesion; 3) Supported by the fiberoptic smear biopsy channel, the position must be fixed before pumping, the suction negative pressure is maintained at 20ml, and the pumping can be reciprocated 3 to 4 times in different directions, which can increase the positive rate; 4) Perform TBNA first, then biopsy and brushing to avoid contamination and false positives. Not suitable for the crowd Inappropriate population: can not tolerate general anesthesia; superior vena cava syndrome; previous mediastinal radiotherapy, mediastinoscopy, median sternotomy or tracheotomy; aortic arch aneurysm. Adverse reactions and risks Nothing.