[Endoscopic approach to pulmonary diseases: Usefulness of the mediastinoscopy]

The purposes of this study are to show the diagnostic values and the role of the mediastinoscopy for the respiratory diseases. From 1971 to 1998, mediastinoscopy were performed on 1664 patients admitted to our hospital with respiratory diseases. For the superior mediastinal diseases, mediastinal tumor and lymphadenopathies without cancer, two or three samples were obtained by mediastinoscopy. For lung cancer, biopsy was routinely performed at the 6 nodal stations, right and left paratracheal (#2), right and left tracheobronchial (#4), pretracheal (#3), and subcarinal (#7) lymphnodes. From 1994, we have used video-mediastinoscopy, which was combined with scope and TV-camera. Using video-mediastinoscopy, many staffs could observe the mediastinal findings on TV-monitor during mediastinal manipulation. The positive findings were observed in 17% (221/1299) for lung cancer, 100% (32/32) for sarcoidosis, 100% (2/2) for malignant lymphoma, 65% (11/17) for mediastinal tumor, 9.8% (13/132) for pulmonary tuberculosis. The positive rate according to the histological types of lung cancer were 20.5% (148/721) for adenocarcinoma, 9.4% (39/415) for squamous cell carcinoma, 31.6% (24/76) for small cell carcinoma, 21.3% (10/47) for large cell carcinoma. Complications developed in a total of 3.6%, and these were bronchial arterial damage(1.8%), recurrent nerve paralysis(0.7%), azygos vein damage (0.4%), pleural rupture(0.4%), superior vena cava damage(0.2%) and tracheal laceration(0.1%). However, there were no severe complications and operative deaths in this series. Mediastinoscopy is a minimal invasive and safety surgical procedure that is widely used as a diagnostic method for investigating the superior mediastinum, mediastinal tumor and lymphadenopathies. It is useful for obtaining histological diagnosis, as well as for staging lung cancer. Video-mediastinoscopy is more safety and educational, because many staffs could observe the findings.