Aljehani Yasser, Elghoneimy Yasser, Alghamdi Zeead, Alreshaid Farouk T, Alsadery Humood A, Othman Sharifah, Bamalan Omar A, Aboollo Moustafa
Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Department of Cardiothoracic Surgery, Menoufia University, Egypt.
Med Arch. 2023;77(6):477-481. doi: 10.5455/medarh.2023.77.477-481.
Since its introduction in 1959 by Carlens (1), Mediastinoscopy has been, for long, used for assessment of the mediastinum (superior and middle) for establishing a histological diagnosis of mediastinal masses of undefined cause, and for Lung carcinomas staging. The use of Mediastinoscopy has been decreasing lately due to the introduction of other less invasive techniques (e.g., endoscopic ultrasound-directed fine needle aspiration cytology), however, it is still a cheap and effective tool that can be utilized in underprivileged centers.
To emphasize how does Mediastinoscopy plays an important role in confirming the clinical diagnosis of isolated mediastinal lymphadenopathy and reviewing its utility.
These are a retrospective analysis of medical charts for patients who underwent diagnostic cervical mediastinoscopy during (2012 - 2018) at a University hospital in Saudi Arabia. The included patients are presented with an isolated mediastinal lymph node enlargement, in the absence of underlying cause and was found to be significant (>1cm in its short axis) by computed tomography. The patient who had a known cause (e.g., Sarcoidosis) or were diagnosed via other tools, was excluded.
Mediastinoscopy was performed on 56 patients, 38 of them were males (68%) and 18 females (32%), with a mean age of (37.5 ± 10 years). The patients' most common presenting symptoms were persistent cough (49%), fever of unknown origin (38%) and weight loss (36%) with an average of 2 symptoms per patient, while in 4 patients (7%) lymphadenopathy was discovered incidentally during the CT scan for other reasons. In addition, the histopathological examination of specimens obtained confirmed the most common diagnoses, Sarcoidosis in 17 patients (30%), lymphoma in 12 patients (21%) and TB in 10 patients (18%). The mean hospital stay (calculated from the day of the procedure) was (2.5 ± 4 days) including work up, with only one mortality (2%) and 3 patients (5%) had experienced post-operative complications.
The diagnostic Mediastinoscopy is both safe and efficient in the diagnosis of patients with isolated mediastinal lymphadenopathy, requiring a minimal surgical setup and is considered cost-effective. Therefore, it is a valid choice of investigating such cases in other underprivileged centers, as it reaches a tissue-based diagnosis, while other techniques are used for staging purposes.
自1959年卡伦斯引入纵隔镜检查术以来，长期用于评估纵隔（上纵隔和中纵隔），以对病因不明的纵隔肿块进行组织学诊断，以及用于肺癌分期。由于其他侵入性较小的技术（如内镜超声引导下细针穿刺细胞学检查）的出现，纵隔镜检查术的使用近来有所减少，然而，它仍是一种廉价且有效的工具，可在资源有限的医疗中心使用。
强调纵隔镜检查术在确诊孤立性纵隔淋巴结病的临床诊断中如何发挥重要作用，并回顾其效用。
对沙特阿拉伯一家大学医院2012年至2018年期间接受诊断性颈部纵隔镜检查的患者病历进行回顾性分析。纳入的患者表现为孤立性纵隔淋巴结肿大，无潜在病因，经计算机断层扫描发现短轴直径大于1cm。已知病因（如结节病）或已通过其他检查手段确诊的患者被排除。
对56例患者进行了纵隔镜检查，其中38例为男性（68%），18例为女性（32%），平均年龄为（37.5±10岁）。患者最常见的症状为持续性咳嗽（49%）、不明原因发热（38%）和体重减轻（36%），平均每位患者有2种症状，4例患者（7%）因其他原因在CT扫描时偶然发现淋巴结病。此外，对获取的标本进行组织病理学检查证实了最常见的诊断，结节病17例（30%）、淋巴瘤12例（21%）和结核病10例（18%）。平均住院时间（从手术日开始计算）为（2.5±4天），包括检查时间，仅1例死亡（2%），3例患者（5%）出现术后并发症。
诊断性纵隔镜检查术在诊断孤立性纵隔淋巴结病患者中既安全又有效，所需手术设备简单，且具有成本效益。因此，在其他资源有限的医疗中心，它是调查此类病例的有效选择，因为它能实现基于组织的诊断，而其他技术则用于分期目的。
