| BackgroundThe mediastinum is generally defined as the interval between the right and left pleural sacs. It extends from the sternum in front to vertebral column behind, and from the thoracic inlet above to the diaphragm below. Its lateral wall is the, mediastinal pleura of both sides. The mediastinum is divided into superior and inferior mediastina by the line drawn horizontally from the sterna angle to the lower border of4th thoracic vertebra. The inferior mediastinum is subdivided into three parts:①an anterior mediastinum in front of pericardium;②a middle mediastinum containing the pericardium with heart and great vessels;③the posterior mediastinum between pericardium and vertebral column. The posterior mediastinum extends to the lower border of the8th thoracic vertebra, its main contents are the bronchi, esophagus, vagus and phrenic nerves,thoracic duct etc. The diagnosis of Mediastinal lesions is the difficulty of clinical work because of its complexity and particularity of the mediastinal anatomical structures. Mediastinal lesions is divided into primary tumors and secondary tumors. Secondary tumors is more common. lung cancer is the most common in the mediastinal lymph node metastasis. Tumor’stage has always been important, Lung cancer is the leading cause of death from cancer in developed countries., TNM classification of lung cancer is equally important, TNM classification is a very important tool for optimal treatment in non-small lung cancer. Minimally invasive techniques for the diagnosis of mediastinal disease and lung cancer TNM staging are exploratory thoracotomy, video asslsted thoracic operation, mediastinoscopy or video mediastinoscopy,Radiological imaging methods and Imaging guided puncture technique which is include Guided-technique of X-ray, CT guided-technology, PET-CT guided-techniques, magnetic resonance (MR) guided technique, ultrasound-guided technology. The mediastinoscopy surgery is the gold standard for diagnosis of mediastinal disease and mediastinal lymph node. However Its damage, complications and high costs restrict the application of this technology in the clinical.Zhang Xuezhe reported CT-guided percutaneous lung biopsy diagnosis of mediastinal lesions for the first time in1997in china. CT scan is not clear enough contrast between the organization, puncture is easy to damage important blood vessels, leading to serious complications. Enhanced scanning can improve the contrast,however the strengthening time is short so that it need inject contrast agent repeatedly. X-ray irradiation dose is not conducive to long-term operation for surgeon, and also a huge risk to patients. Diagnostic accuracy of CT-guided percutaneous lung biopsy has a big difference about65-90%in many study. PET-CT has been put into use in1998.It has become the new imaging equipment which is the fastest growing of utilization rate in the world. It has been shown that PET-CT is a more accurate and sensitive method than CT in the staging process. PET-CT allowed the correct classification of the T, N, M,. Radiological imaging methods are the basic methods in early diagnosis of this disease. But PET-CT Still has a certain false-negative.Ultrasound-guided technology developed rapidly in the medical field. The mid-1980s, The foreign carry out the transbronchial needle aspiration(TBNA). A research had reported by wang about fiberoptic bronchoscopy TBNA biopsy of mediastinal lesions, the diagnosis rate is different from47%to87%. TBNA only based on imaging information,it is easy to cause complications like pneumothorax,Bleeding, mediastinal emphysema and so on. EBUS-TBNA become an important diagnostic tool for clinicians.For mediastinal benign lesions, EBUS-TBNA can be given with only the clinical value of the diagnosis rate of47.22%.There are two ultrasound probe forms, RB-EBUS and CP-EBUS. CP-EBUS is the mainly form in our country.a new bronchoscope equipped with a convex type ultrasound probe on the tip was introduced into clinical practice. This convex probe endobronchial ultrasound (CP-EBUS) provides a long axis image of surrounding structures of the major airway. The CP-EBUS combined with a dedicated biopsy needle allows real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. Samples obtained from EBUS-TBNA can be used for pathological diagnosis including immunohistochemistry. According to the relevant literature, EBUS-TBNA both have the higher sensitivity and specificity. But the problem is that false negative is also high. EBUS-TBNA are based less cytopathology diagnosis, there is a certain degree of difficulty for getting histological diagnosis.Medical ultrasonic endoscope technology is mature, the inner diameter of the ultrasound probe more and more in recently.Ultrasound probe from12MHz,20MHz to30MHz, the resolution is improved significantly.The usefulness of endobronchial ultrasonography (EBUS) with guide-sheath (GS) as a guide for transbronchial biopsy for diagnosing peripheral pulmonary lesions and for improving diagnostic accuracy was evaluated in Herth’s study in1992. Nakamura found that ultrasound probe with30MHz has higher resolution structure of the bronchial wall layers. Rigid bronchoscopy also known as ventilation bronchoscopy, more than100years of clinical history. Now Rigid bronchoscopy has much more attention by many doctors than before because of the development of interventional pulmonology techniques.ObjectiveMinimally invasive techniques for the diagnosis of mediastinal disease and lung cancer TNM staging are exploratory thoracotomy, video asslsted thoracic operation, mediastinoscopy or video mediastinoscopy, radiological imaging methods and Imaging guided puncture technique which is include Guided-technique of X-ray, CT guided-technology, PET-CT guided-techniques, magnetic resonance (MR) guided technique, ultrasound-guided technology. The mediastinoscopy surgery is the gold standard for diagnosis of mediastinal disease and mediastinal lymph node. However Its damage, complications,high costs and High rate of false-negative restrict the application of this technology in the clinical.Puncture techniques include fine needle aspiration, core needle, cut slots needle on its own advantages and disadvantages.To make up for the deficiencies of the above technologies,we design a new system, which is identified mediastinal lesions, obtain accuracy of pathological result, which helped to determine the diagnosis and treatment of the disease for clinician.MethodsThe system combined Ultrasonic-Probe with Ultrasound catheter—a new medical ultrasound technique and Rigid Bronchoscopy(RB) improved, assisting Vacuum-assisted biopsy device, which allowed doctors to acquire mediastinal lesions and get histopathologic diagnosis. endobronchial ultrasonography (EBUS) using a guide sheath (EBUS-GS) with30MHz Can clearly show the location of the lesions and vascular and avoid puncturing blood vessels. The diameter of the rigid bronchoscopy reduce appropriatly to alleviate the suffering of patients. Ultrasound probe and biopsy needle has been put into working channel of the rigid bronchoscope and reach to trachea. The ultrasound probe understand the location of diseased tissue and blood vessels, Vacuum-assisted biopsy device gets diseased tissue quickly and repeatedly.ResultsAnatomical structures based on human trachea, bronchus and mediastinal anatomical structures, combined with the actual clinical application, we have modified the original rigid bronchoscope diameter. Outside diameter is6mm, and a thickness of1mm, and the inner diameter of4mm. The outer diameter of the RB is decreased in order to deduce pain and complication rate, with the help of Ultrasonic-Probe it allows blood vessels to be identified and avoids puncturing the vessels, Vacuum-assisted biopsy device gets diseased tissue quickly and repeatedly. Vacuum biopsy device suction lesions into notch and cut lesions.ConclusionThe novel Endobronchial Sonography Rigid Bronchoscopy Assisted Vacuum-assisted biopsy device has many remarkable advantages, such as enlarging the applied range of the RB, which is extended from endobronchiall lesions, obtaining multiple samples with a higher accuracy rate and a lower false negative rate than other sampling techniques, avoiding contamination during the procedure and minimizing operation time that alleviate pain and decreased the cost of diagnosis and cure, Makes up the technical deficiency to a certain degree. |
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