• Journal of Chest Surgery
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• 제24권8호
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• pp.751-756
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• 1991

For the period from June 1988 to July 1991 we studied 29 patients who were judged to have operable disease before mediastinoscopy on clinical criteria[absence of distant metastases, phrenic or laryngeal nerve paralysis, positive scalene node biopsy, and malignant pleural effusion]. All patients had computed tomography and mediastinoscopy prior to operation. In the present study, the sensitivity, specificity, and accuracy of CT were 92%, 56%, and 72%, respectively. And the sensitivity, specificity, and accuracy of mediastinoscopy were 92%, 100%, and 97%, respectively. We concluded that because of the low accuracy of CT, CT cannot replace mediastinoscopy, and routine mediastinoscopy should be performed in preoperative staging of bronchogenic carcinoma.

• Journal of Chest Surgery
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• 제28권1호
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• pp.37-41
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• 1995

To determine the role of mediastinoscopy in the preoperative staging of the primary lung cancer, we studied 23 patients from January 1993 to December 1993 and compared the results of mediastinoscopy and computed tomographic scanning with the findings at thoracotomy. Mediastinoscopy was performed in 14 patients when they had larger than 10mm mediastinal nodes at computed tomographic scanning. Six of them were found to have metastatic nodes. Nine patients, who had negative computed tomographic scanning and negative mediastinoscopic results,underwent thoracotomy. One of them was found to have a metastatic mediastinal lymph node. When results from both series of patients were compared, the sensitivity and specificity of computed tomographic scanning showed 83.3% and 47.1% respectively with an accuracy of 56.5%. The results of mediastinoscopy showed that the sensitivity was 85.7%, the specificity was 100% and the accuracy was 95.7%.Because of the low accuracy rate of computed tomographic scanning, a more routine use of mediastinoscopy seems to be justified.

• Journal of Chest Surgery
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• 제10권2호
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• pp.349-354
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• 1977

Mediastinoscopy is a surgical endoscopic technique used mainly for examination and biopsy of lesions of the superior and posterior middle mediastinum. It is particularly concerned with diseases that primarily or secondary involve the paratracheal and parabronchial lymphatics. A total of 18 cases of mediastinoscopy are presented with a detailed analysis of indications and results. Of these mediastinoscopy was positive in i0 [56%] and negative in 8 [44%]. The 10 positive mediastinoscopies were diagnostic in 4 patients with malignant lymphoma, 5 patients with carcinoma of the lung, one patient with active pulmonary tuberculosis. Of 8 negative mediastinoscopies, one was inoperable due to recurrent laryngeal nerve involvement, 7 patients were subjected to radical resection. Complications of mediastinoscopy were developed in 2 cases, one was minimal degree of subcutaneous emphysema on anterior chest wall, and the other was widening of right mediastinal border due to hematoma. Two complications were completely absorbed after 7 days.

• Journal of Chest Surgery
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• 제15권4호
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• pp.467-472
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• 1982

Fifty six consecutive cases of mediastinoscopy are analysed. The procedure was performed without any complication and mortality. It is concluded that the mediastinoscopy is a safe procedure and causes little disturbance to the patient. The value of mediastinoscopy as a diagnostic procedure for mediastinal and pulmonary hilar masses is shown. In my series, mediastinoscopy was performed in 17 cases, which could not be diagnosed by other means, for purpose of diagnostic procedure. A histologic diagnosis was obtained in 11 of the 17 patients [64.7%]. The findings are 6 cases of tuberculosis, 2 cases of metastatic carcinoma, 1 case of primary carcinoma, and one case of noncaseating granuloma. The histologic diagnosis of carcinoma in patients believed to have non-resectable tumors could be obtained in 4 of the 7 cases [57.1%]. Three cases out of 32 patients with presumably resectable bronchial carcinoma were found to have mediastinal lymph node metastases. Two patients of 29 cases refused to be operated on. The remaining 27 cases had thoracotomy and resection was undertaken in all but 9 cases [33.3%].

• Journal of Chest Surgery
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• 제26권9호
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• pp.705-709
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• 1993

The mediastinoscopy was a well known useful diagnostic tool for detection of certain mediastinal tumors ,mediastinal lymph nodes invasion by bronchogenic carcinoma and metastatic cancer. A total of 33 cases of mediastinoscopies were reviewed, which were experienced at Chon Buk National University Hospital from August,1980 to October 1991. Mediastinoscopy was performed through anterior or parasternal approach in 18 cases, cervical approach in 14 cases and both in 1 case. In 12 cases which were used for preoperative stagig of lung cancer, 10 cases[83.3%] had the positive biopsy results at mediastinal nodes. In 11 cases for diagnosis of lymph nodes and masses with unknown lung lesion, small cell carcinoma revealed in 3 cases,squamous cell carcinoma in 2 , adenocarcinoma in 1 case and the others were had the negative biopsy results. In 10 cases for diagnosis of mediastinal tumors, lymphoma revealed in 2 cases, malignant thymoma in 2, sarcoidosis in 2, tuberculous granuloma in 1, mesothelioma in 1, metastatic cancer with unknown origin in 1 case. Thoracotomy was performed in 3 cases of lung cancers, 2 patients with negative biopsy results in preoperative staging and 1 patient with subcarinal lymph node involvement only. Bleeding complications during mediastinoscopy were developed in 2 cases, managed by anterior mini-thoracotomy.

• Journal of Chest Surgery
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• 제18권4호
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• pp.855-858
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• 1985

The mediastinoscopy was a well known useful diagnostic tool for detection of mediastinal lymph nodes invasion by bronchogenic carcinoma, and also useful means for histologic diagnosis of metastatic carcinoma and certain mediastinal tumors. 31 cases of mediastinoscopies were reviewed which were experienced at Kyung Hee University Hospital from July, 1979 to June, 1985. We experienced 20 cervical mediastinoscopies, 10 left anterior mediastinotomy, and 1 both procedures. Of the 31 cases, 22 cases were used for preoperative staging of bronchogenic carcinoma, 7 cases for mediastinal tumor diagnosis, and 2 cases for histologic diagnosis of metastatic carcinoma. In 22 mediastinoscopies which were used for preoperative staging, 10 cases were revealed positive mediastinal nodes, and could avoid meaningless thoracotomy. All 12 mediastinoscopy negative patients were received thoracotomy, and 10 of them were resectable. The resectability in bronchogenic carcinoma was 83%, on the contrary, the other series at premediastinoscopic era revealed only 65% resectability. Other mediastinal lesions such as tuberculous granuloma [4], sarcoidosis [2], malignant thymoma [1], and metastatic carcinoma [2] were also diagnosed successfully. Mediastinoscopy is very useful tool for determination of treating method of bronchogenic carcinoma, and for diagnosis of certain mediastinal tumors which, otherwise, need a thoracotomy for confirmatory diagnosis.

• Journal of Chest Surgery
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• 제39권6호
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• pp.470-474
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• 2006

배경: 종격동 림프절 전이 여부는 비소세포폐암의 병기 결정과 예후에 중요한 인자이며, 정확한 진단이 치료 방법결정에 필수적이다. 종격동경검사는 조직병리학적으로 종격동 림프절 전이 여부를 진단할 수 있는 방법으로, 그 유용성에 대해 알아보고자 하였다. 대상 및 방법: 1999년 6월부터 2005년 8월까지 비소세포폐암으로 진단 받고 종격동경검사를 시행하였던 환자 348명을 대상으로 환자의 특성, 방사선학적 검사 결과, 종격동경검사 결과 및 최종 병리학적 병기 등을 후향적으로 조사하여 종격동경검사의 안전성과 유용성을 평가하였다. 결과: 연구대상 환자 348명 중 남자가 263명 여자가 85명이었고 평균 연령은 $62.1{\pm}8.5$세이었다. 203명은 방사선검사에서 종격동 림프절 전이가 없는 것으로 진단되었고 145명에서는 전이가 있는 것으로 진단되었다. 종격동경검사에 걸린 시간은 평균 $55.5{\pm}16.5$분이었고, 평균 $2.2{\pm}1.0$개의 림프절군에서 생검을 하였다. 검사 중 5예(1.7%)의 일시적인 합병증이 발생하였으나, 그 외의 합병증이나 사망은 없었다. 종격동경검사의 위음성률은 7.8%였다. 종격 동경검사는 민감도(77.5% vs 71.9%, p=0.012), 특이도(100% vs 74.4%, p=0.00) 및 정확도(92.2% vs 73.6%, p=0.00) 등이 방사선 검사에 비해 유의하게 높았다. 결론: 종격동경검사는 절제가능한 비소세포폐암에서 치료 전 종격동 림프절 전이 여부에 대해 진단할 수 있는 안전하고 효과적인 방법이다.

• Journal of Chest Surgery
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• 제38권3호
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• pp.229-232
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• 2005

요부 교감 신경 절제술은 족부 다한증, 하지 혈관 질환 및 신경계 질환의 치료를 목적으로 시행되는 수술로 흉부교감 신경 절제술에 비해 수술 빈도는 많이 떨어지나, 최근의 수술 경향인 최소 침습 수술의 발달과 복강경을 이용한 요부 교감 신경 절제술이 소개되면서 관심이 증가되었다 대상 및 방법: 2003년 7월부터 2004년 12월까지 18명의 환자에서 종격동경을 이용한 요부 교감 신경 절제술을 시행하였는데 환자의 남녀비는 12:6으로 남자가 많았고 평균 연령은 24.3세였으며, 수술 부위는 12명의 족부 다한증 환자에서는 양측을 수술하였고 나머지 6명의 환자에서는 좌측 4예, 우측 2예의 수술을 시행하여 총 30예의 요부 교감 신경 절제술을 시행하였다. 결과: 평균 수술 시간은 37.2$\pm$12.5 분이었으며 수술 후 평균 재원일은 3.1$\pm$2.2일이였다. 결론: 종격동경을 이용한 요부 교감 신경 절제술은 간단하고 효과적인 수술 방법으로, 미용적인 측면과 수술 후 동통의 감소 및 수술 후 재원 기간의 단축 등의 장점이 있는 수술이라고 생각되며, 향후 더 많은 수의 환자에서 결과를 분석하여 더 나은 결과를 가져올 수 있다고 예상된다.

• Journal of Chest Surgery
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• 제40권11호
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• pp.745-751
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• 2007

배경: 폐암환자에서 수술 전에 종격동 림프절의 전이 여부를 확인하기 위해 종격동경이 많이 이용되고 있으나 수술의 적응이 되는 모든 환자에서 종격동경을 시행할 것인지에 대해서는 논란의 여지가 있다. 이에 본 연구에서는 모든 비소세포성폐암 환자에서 통상적으로 종격동경을 시행하는 것이 임상적으로 의미가 있는지 살펴보고자 하였다. 대상 및 방법: 2002년 3월부터 2004년 12월까지 비소세포성폐암으로 진단받고 수술을 시행한 90명의 환자를 대상으로 방사선학적 검사와 종격동 검사를 시행하여 각 검사의 민감도, 특이도, 양성예측치, 음성예측치, 정확도를 비교하였고 방사선학적 N0/1기군과 N2/3기군에서 이들 수치를 분석하여 각 군에서 종격동경 검사가 임상적으로 의미를 가지는가를 후향적으로 분석하였다. 결과: 방사선학적 검사와 종격동경의 민감도, 특이도, 정확도를 비교하였을 때 민감도에는 차이가 없었으나 특이도, 정확도는 종격동경 검사가 우수하였다. 방사선학적 N0/1기군은 62명으로 이 군에서 시행한 종격동경의 민감도는 28.6%였고 방사선학적 N2/3기군은 28명으로 이 군에서의 종격동경의 민감도는 72.7%로 방사선학적 N0/1기군에서의 민감도가 N2/3군에 비해 아주 낮았다. 종격동경으로 진단이 되지 못한 N2/3 양성인 환자 8명 중 7명의 환자에서 수술 시 용골하 림프절의 전이가 확인되었다. 결론: 술 전 병기결정에 종격동경이 종격동 림프절의 전이를 진단하는 가장 정확한 방법이지만 침습적 방법이라는 점과 일부 림프절만이 검사가 가능하다는 점, 방사선학적 N0/1기군에서 특히 낮은 민감도를 고려할 때 모든 군에서 종격동경을 시행하는 것은 임상적 의미를 찾기 어려웠으며 방사선학적 병기 N2/3군에서 선택적으로 종격동경 검사를 시행하는 것이 유용할 것으로 생각한다.

• Journal of Chest Surgery
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• 제20권3호
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• pp.548-551
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• 1987

Thoracoscopy, mediastinoscopy and/or mediastinotomy and explo-thoracotomy were performed and confirmed diagnosis of the 26 cases of the mediastinal tumors, those were admitted and treated at the Department of Thoracic and Cardiovascular surgery, Chonbuk National University Hospital, from June,1976 to September, 1986. We experienced 7 thoracoscopies, 7 mediastinoscopies &/or mediastinotomies, and 12 explo-thoracotomies. The most common histologic type was teratoma and lymphoma [6 cases]. Of the 26 cases of the histologically confirmed mediastinal tumor, 19 were benign tumors and 7 were malignants. 19 cases of benign tumors were surgically resected with good result but one case of the surgically resected malignant thymoma was recurred 4 months later. 6 cases of malignant lymphoma and one case of recurred malignant thymoma were treated with chemo-and radiation therapy. Thoracoscopy and mediastinoscopy with tissue biopsy were simple in procedure and had a tissue diagnosis with obtaining the pathologic tissue in a acceptable complication rate and reduced exploratory thoracotomy.