PDF(Pubmed)
Abstract：
The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections.
摘要：
纵隔病变的许多原因需要不同的诊断和治疗方法。包括保守派,微创,和手术干预。恶性实性病变,大部分位于前纵隔,在有或没有辅助方案的情况下，都可以通过手术切除进行适当治疗。相比之下,通常建议对实体良性肿瘤进行监测，取决于它们的大小和相关的症状。在纵隔收集的管理中，当需要引流干预时（怀疑感染和症状），考虑微创非手术治疗或胸外科手术。可以使用的微创非手术程序是经皮放射学引导成像（腹部超声（US）或计算机断层扫描（CT）扫描），内窥镜超声（EUS）或支气管内超声（EBUS）引导下的完全单次抽吸，和由EUS引导的透壁引流。手术清创治疗集合是可行的，但是由于这带来了相当大的术后并发症的风险，只有当其他微创治疗是不可能的时候才选择。与介入内镜治疗纵隔病变相关的已发表文献很少。然而，该领域的报告显示，介入性EUS可能在纵隔病变的诊断和治疗方法中发挥作用。主要是在纵隔收集的管理。
