Mehmet DAKAK, Metin ÖZKAN, Sedat GÜRKÖK, Alper GÖZÜBÜYÜK, Orhan YÜCEL, Hasan ÇAYLAK, Ersin SAPMAZ, Kuthan KAVAKLI

Akciğer kanseri dışında mediastinal lenfadenopati ile seyreden hastalıklarda servikal mediastinoskopinin tanısal değeri

Amaç: Bu çalışmada hastalara uygulanan servikal mediastinoskopi (SM)�nin etkinliği, güvenilirliği ve uygulanabilirliği ortaya kondu.Çalışma planı: Mediastinal lenfadenopati nedeniyle tanısal amaçlı SM uygulanan 84 olgunun (68 erkek 16 kadın; ort. yaş 34.6 yıl; dağılım 20-71 yıl) verileri geriye yönelik olarak incelendi. Olgular yaş, cinsiyet, ameliyat süresi, lenfadenopati saptanan ve örnekleme yapılan lenf nodu istasyonlarının dağılımı, ameliyat sırası ve ameliyat sonrası mortalite, morbidite ile histopatolojik tanı parametreleri açısından değerlendirildi.Bulgular: Olguların radyolojik incelemelerinde toplam 233 lenf nodu istasyonunda lenfadenopati saptanırken uygulanan mediastinoskopilerde %77�si sağ üst paratrakeal ve sağ alt paratrakeal (2R, 4R) lenf nodlarından olmak üzere 140 lenf nodu istasyonundan örnekleme yapıldı. Dört olguda (%4.8) komplikasyon saptanırken hiçbir olguda mortalite gözlenmedi. Kesin tanısı torakotomi ile konan iki olgu haricinde tüm olgularda histopatolojik tanı mediastinoskopi ile kondu. Akciğer kanseri olmayan hastalarda mediastinoskopinin duyarlılığı %93 olarak saptandı.Sonuç: Bu veriler ışığında mediastinoskopi, tanısı konulamamış mediastinal lenfadenopatili hastaların büyük bir kısmında düşük mortalite ve morbidite oranları ile güvenle uygulanabilen tanısal değeri yüksek invaziv bir tanı yöntemidir.

The diagnostic value of cervical mediastinoscopy in the diseases with mediastinal lymphadenopathy other than lung cancer

Background: In this study, reliability, effectivity and practicability of cervical mediastinoscopy was determined.Methods: The data were retrospectively analyzed 84 patients (68 males 16 females; mean age 34.6 years; range 20 to 71 years) who underwent diagnostic mediastinoscopy due to mediastinal lymphadenopathy. The patients were analyzed in terms of the variables of age, sex, duration of operation, the distribution of detected and sampled lymph node stations, peri- and postoperative mortality, morbidity and histopathological diagnosis.Results: Lymphadenopathy was dedected in 233 lymph node stations by means of radiological examinations. One hundred forty of all lymph node stations were sampled and 77% of these samplings were performed from right upper and right lower paratracheal lymph node stations (2R, 4R). There were complications in four cases (4.8%) but no mortality occurred. Histopathological diagnosis was established by mediastinoscopy in all but two patients in whom the diagnosis was established by thoracotomy. The sensitivity of mediastinoscopy in patients without lung cancer was 93%.Conclusion: In the light of these findings, mediastinoscopy is an diagnostic method which has a high diagnostic value and which can be performed with low morbidity and mortality rates in the majority of patients who have undiagnosed mediastinal lymphadenopaties.

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