Adebibe Miriam, Jarral Omar A, Shipolini Alex R, McCormack David J
Department of Cardiothoracic Surgery, The London Chest Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2012 Mar;14(3):316-9. doi: 10.1093/icvts/ivr052. Epub 2011 Dec 2.
A best evidence topic was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) has a better lymph node yield and safety profile than the conventional mediastinoscopy (CM). A total of 194 papers were found, using the reported searches, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two studies to date have directly compared CM and VAM with respect to lymph node yield, calculated diagnostics performance and complication rate. In both of these, lymph node yield is shown to be higher using VAM with better sensitivity, negative predictive value and accuracy rates. The favourable figures of lymph node sampling are found to be statistically significant in the single study providing such analysis. Complication rates using VAM are low, however, in the one instance where it is reported as higher than CM, the extensive lymph node dissection used in this technique may be a reasonable explanation for this finding. All studies described here exemplify VAM as a safe and useful tool in mediastinal staging, lymph node dissection and tissue diagnosis of mediastinal diseases given its superior visualization of surrounding structures and advantage of bimanual dissection. The future scope for diagnostic and therapeutic indications of cervical mediastinscopy is anticipated with recent advances and new techniques, such as video-assisted mediastinoscopic lymphadenectomy and virtual mediastinscopy.
根据结构化方案撰写了一篇最佳证据主题。所探讨的问题是，与传统纵隔镜检查（CM）相比，电视辅助纵隔镜检查（VAM）是否具有更高的淋巴结检出率和更好的安全性。通过报告的检索共找到194篇论文，其中5篇代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表日期和国家、研究的患者组、研究类型、相关结果和结果制成表格。迄今为止，有两项研究直接比较了CM和VAM在淋巴结检出率、计算诊断性能和并发症发生率方面的差异。在这两项研究中，VAM的淋巴结检出率均较高，敏感性、阴性预测值和准确率也更高。在提供此类分析的单项研究中，淋巴结采样的良好数据具有统计学意义。VAM的并发症发生率较低，然而，在有一例报告其高于CM的情况下，该技术中广泛的淋巴结清扫可能是这一发现的合理解释。鉴于其对周围结构的卓越可视化以及双手操作解剖的优势，本文所述的所有研究均表明VAM是纵隔分期、淋巴结清扫和纵隔疾病组织诊断中的一种安全且有用的工具。随着视频辅助纵隔镜淋巴结切除术和虚拟纵隔镜等最新进展和新技术的出现，预计颈部纵隔镜检查在诊断和治疗方面的未来应用范围将会扩大。
