Mediastinoscopy and mediastinotomy

Mediastinoscopy and mediastinotomy

Applied to evaluate the indications for mediastinoscopy in lung cancer surgery. Furthermore, other diseases such as cancer, lymphoma, tuberculosis and related lenfadanopatilerin diagnosis of sarcoidosis is useful.

An incision made ​​between the cartilage and suprasternal notch Mediastinoscopy trioid are entering. Mediastinoskopla paratrakea, tracheo-bronchial lymph glands and peribronş visualization, biopsy is done. This method is not possible to see the hilar and aorto-pulmonary lymph nodes. PET has a complication rate of 3%. The major pneumothorax, bleeding and laryngeal nerve injury of the esophagus and trachea.
Parasternal mediastinoscopy is an incision. The main indication for anterior mediastinum and left upper lobe lung cancer, and other aorto-pulmonary lymph nodes are for appearance and biopsy. Complications of mediastinoscopy is the same.

0. Period negative radiological findings, negative bronchoscopic findings, positive sputum cytology. These findings are small in diameter, is hidden or in situ indicated a counter-nomade. Where the patient was diagnosed of cancer surgery should be closely monitored.

1. Term: (a) Radiography peripheral edge has a tumor. Signs of bronchial obstruction, no signs of metastasis or invasion. Surgical resection is the initiative, (b) do not make a large bronchus obstruction of the small but has a tumor. There is no sign of metastasis in the lymph gland. Surgical resection is the initiative.
2. Period radiography or bronchoscopy, or a segment of the tumor lobe bronchus is blocked. There is no sign of metastasis. Resection is applied.
3. Term: (a) are adenopatisi hilus. However, no signs of mediastinal and distant metastases adenopatisi, (b) are adenopatisi hilus. Adenopatisi no signs of mediastinal and distant metastases. Chest wall tumor progressed. However, resection can be done.
4. Period There is no indication for surgical intervention, because the tumor medi-Asten, has invaded the pleura and vessels, are scalene lymph gland metastasis, the operation has progressed beyond the chest wall or brachial plexus, or there are distant metastases.

Early diagnosis of cancer

Early lung cancer, surgery removed the entire duration of a recovery and normal life can be provided by cause.
Less than 20 mm in diameter, pleura, lymph nodes, tumors have no chance to live near or distant metastasis according to tumor diameter greater than 20 mm is 80%. Certainly increases the chances of early diagnosis of cancer therapy.

Early lung cancer in two groups:

Hilar early lung cancer, bronchial tumor in the wall and pleura, lymph node or distant metastases do not. Research, screening or diagnostic examination of sputum is sitoloik many times. This type of early lung cancer "hidden cancer" is the name. Localization is difficult to determine. Bronkofiberskop increased the chances of this cancer diagnosis.

Early lung cancer often does routine radiography. Sometimes the lines extending to the periphery of the tumor is seen in the hilus, pnömonitis'in similar radiographic appearance. This finding is important for the tumor, the lateral radiography, computer tomography, cytological examination of sputum and bronkofiberskopla assessed. In some cases of early hilar lung cancer-a long-term chronic cough, sputum production (especially bloody sputum), such as subjective symptoms, diagnosis, consists of the router. The age of a patient who smoked more than 40 percent in the past, and especially long-term cough and phlegm landing bronkofîberskopi If there is indicated. If you doubt this indication is even more difficult to win the bloody sputum.

2. Peripheral-type early lung cancer, the tumor is less than 20 mm in diameter. Pleura, lymph node and no distant metastases. These tumors can be seen in lung radiography. An abnormal shadow in the peripheral lung X-ray computer tomography bronkografıyle be examined and, if necessary. This investigation is supported by an abnormal radiographic findings do bronchoscopy and cytological diagnosis of the material must be obtained by brushing and küretle. In such cases, the success of diagnosis is approximately 80%. If you are negative results of cytological and control of cancer in needle biopsy of suspected rontgenoscopy continues to do, and that success should be provided, thoracotomy.


There are different methods of biopsy for the diagnosis of lung cancer: Bronkos-endoscopic biopsy, closed or open lung and pleural biopsy, and mediastinoscopy in mediastinal lymph node biopsy, such as scalene lymph node biopsy. The biopsy technique applied to the success of their personal experience, according to information received from reviewing the material cytological changes.
With the help of computer tomography diagnosis of tumors by needle aspiration is a useful and meaningful way that is easy to obtain material.

Laboratory investigations

Cytological examination of sputum, bronchial lavage and pleural fluid cytological examination is very important in the diagnosis of lung cancer. Solo sputum cytologic diagnosis of lung cancer by studying the rate is about 70%. Cytological examination of the material obtained from the sputum and bronkoskopiyle 95% of the applied diagnostic finds.
Paraneoplastic syndromes related to laboratory analysis and are used in current investigations. Sedimentation rate of lung cancer increases.

Morning deep, strong cough following the sputum is preferred. Saliva is not useful for this purpose be analyzed. You can not make it easier methods of sputum expectoration in patients aerasyon inhalation should be tried, for example. Postural drainage and chest percussion by sputum increases the chance. Blood and sputum should be preferred in the dark. 3 or 6 different from the homogeneous appearance of sputum examined. Mucus or bronchial lavage was aspirated from each flat is spread, and 3 after being found without delay and 90% alcohol for 30 minutes Papanicolau painted technique. Fixing and staining of sputum was collected the same day, even if possible, sputum should be subtracted. This possibility will be saved until 48 hours or degree of sputum 4. The possibility of storing heat or sputum smear should be determined after the alcohol. Some laboratories Papanicolau review negative, positive, and interpret as suspicious. Some of them re-examine whether negative or positive instead of suspicious findings make two comments.
If more than one increases the chances of success in dissemination. Given the context of sputum-positive finding only about 35%, 75% of the four lambda is judging.

Serum biochemical examination dehidrojenez total lactic (LDH) in 40% of all cancer cases will increase.
Cancer disease often have increased metabolic activity. For this reason, food is not taken sufficient time to reduce the blood proteins.
Lung and other cancers in serum karsinoembriojenik antigen (CEA) increases.

Biochemical changes related to tumor metastasis
Akciğer'den especially the liver, bone, cranium, peritoneum, pleura and other organs are metastases. Whether there is an indication for surgical intervention in patients with metastases in these organs should be examined.

Liver and bile duct in cases of metastasis oksalasetik serum glutamic transaminase (SGOT), serum glutamic pruvik transaminase (SGPT), lactic dehydrogenase (LDH) and alkaline phosphatase increased. However, these findings are not specific. . Alkaline phosphatase, bone or bowel disease and Hodgkin's disease, metastasis, or the increase.

Bone metastases, serum calcium rises. Lung cancer, bone metastasis can be monitored without hypercalcemia. Hypercalcemia occurs in cases of hypercalciuria.
Cancer or metastases, pleural and peritoneal fluid LDH in these gaps increases. Pleural or peritoneal metastasis of cancer or are suspected as well as the gaps in both the serum LDH measured in the fluid at the same time. Fluid LDH is a tumor or abnormal and to have more than serumdakinden is an important finding for metastasis.

No comments:

Post a Comment

Ratings and Recommendations by outbrain