OBJECTIVETo investigate the value of mediastinoscopy in diagnosis of the thoracic diseases and the determination of the operative indication.

METHODSFrom 1979 to 2000, 165 patients were given mediastinoscopy by local infiltration anesthesia (rare cases with additional vein bacic anesthesia). The exploration and biopsy were given to the neoplasms and lymph nodes around the trachea through the pretracheal interstice.

RESULTSThe diagnosis of 125 patients by mediastinoscopy accorded with the pathological diagnosis and that of 21 patients was not accorded with the pathology. The rate of definitive diagnosis was 85.6% (125/146). The other 19 cases were not included into the ground because 11 cases were not given definitive diagnosis and 8 cases with lung cancer were not be performed operation although the results of mediastinoscopy were negative. Twenty patients with lung cancer which had metastasis in the mediastium and 7 patients with malignant lymphadenoma avoided exploratory thoracotomy.

CONCLUSIONThe mediastinoscopy is a effective examinative method to the disease involving the lymph nodes in the mediastinum and the thoracic disease closing on the mediastinum. The mediastinoscopy in appropriate especially to the simple enlargement of lymph node in the mediastinum that is not given definitive diagnosis. The cases with lung cancer accompanied enlargement of lymph node in the mediastinum and that with tumors in the mediastinum may choose the mediastinoscopy.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; Lymph Nodes ; pathology ; Male ; Mediastinal Neoplasms ; diagnosis ; Mediastinoscopy ; Middle Aged ; Thoracic Diseases ; diagnosis

BACKGROUNDTo explore the perioperative changes of T subsets and NK cell and analyze the related factors in patients with lung cancer.

METHODSThe T subsets and NK cell from peripheral blood of 60 patients with lung cancer, 15 patients with lung benign tumor and 15 healthy people were detected by immunofluorescence. These indexes of the patients with lung cancer were detected also at postoperative 2nd, 7th, 14th and 28th days.

RESULTS1.There were significant differences in the indexes between the lung cancer group and the groups of lung benign tumor and normal people except for CD8+ (P < 0.05). 2.At postoperative 2nd day CD3+, CD4+, CD4+/CD8+ and NK cell of the patients with lung cancer were decreased and CD8+ was increased significantly than those before operation (P < 0.05). During postoperative 1 to 2 weeks, all indexes had recovered basically to the preoperative level. At postoperative 28th day, CD3+, CD4+ , CD4+/CD8+ and NK cell were increased and CD8+ was decreased than those before operation (P < 0.05). 3. There was significant difference in the indexes among preoperative stage IIIA, IIIB and IB, and between preoperative N2 diseases and N0 group (P < 0.05). There was significant difference between the groups of radical and palliative operation and the group of thoracic exploration at postoperative 28th day (P < 0.05). There was significant difference in T subsets between the groups of blood transfusion and non-transfusion at postoperative 14th day (P < 0.05).

CONCLUSIONSThe cellular immune function of the patients with lung cancer was lower than that of the patients with lung benign tumor and normal people. The perioperative immunity of patients with lung cancer decreases after operation and increases later. TNM stage and lymph node metastasis are relative to preoperative but not postoperative immunity. There is no significant correlation between cellular immune function and pathological type of the tumor. Radical and palliative operations can both significantly increase the patients' cellular immune function. Therefore the palliative operation is better than thoracic exploration. Blood transfusion can depress the immune function of the patients, so it is better to avoid perioperative blood transfusion.