CURRENT SURGICAL METHODS FOR ETIOLOGIC DI AGNOSIS OF MEDIASTINAL LYMPH-NODE DISEASES

The aim of this work was to determine the role of video-thoracoscopy a nd mediastinoscopy for the diagnosis of lymph node enlargement in the mediastinum of unknown aetiology. From January 1992 to December 1993, 26 patients were were seen for surgical biopsy of mediastinal lymph no des. Relative localization and the requirement for an associated gestu re determined the choice between axial mediastinoscopy, parasternal sc opy and videotheroascropy. Mediastinoscopy was performed for peritrach eal or right hilar (Barety) nodes and parasternal scopy for anterior m ediastinal masses. Videothroacoscopy was performed when the lymph node s were localized at the preceeding sites or when an associated manoeuv er was required. Mediastinoscop9y was performed in 16 patients. Lympho rrea which subsided after 4 days occurred in one patient and the mean hospital stay was 2.6 days. Diagnosis was achieved in 15 cases. The de lay from procedure to treatment was 11 days on the average. Parasterna l scopy was used 3 times and gave the diagnosis in all cases. Videotho racoscopy was used for 7 patients including 2 cases with pulmonary bio psies. Diagnosis was established 7 times and the delay to treatment wa s 12 days. No diagnostic thoracotomie were performed during this perio d. When access to the mass to be biopsied is difficult with mediastino scopy (aorto-pulmonary, subcarenal, triangular ligament) videothoracot omy can be useful. Post-operative follow-up is simple and a specific t reatment can be instaured rapidly. Videothoracotomy should be an impor tant supplementary method for mediastinoscopy and helping avoid thorac otomy.