纵隔镜手术在临床N2期肺癌中的应用价值

The value of mediastinoscopy in the staging of lung cancer with clinical N2 disease

背景与目的探讨纵隔镜手术在临床N2期肺癌纵隔淋巴结病理分期中的应用价值。方法回顾性总结1999年9月-2008年4月87例经纵隔镜检查的肺癌患者的临床资料,其中颈部纵隔镜手术83例,胸骨旁视纵隔镜手术4例。术前所有患者胸部CT均发现同侧纵隔和(或)隆突下淋巴结肿大(直径>1.0cm)。结果本组87例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者61例,未见纵隔淋巴结转移(阴性)者26例。纵隔镜检查阴性者中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实24例纵隔淋巴结未见转移,2例隆突后淋巴结可见癌转移(纵隔镜检查假阴性)。纵隔镜手术敏感性、特异性和准确性分别为96.8%、100%和97.7%。本组术中发生无名动脉撕裂1例,并发症发生率为1.1%(1/87)。无围手术期死亡。结论纵隔镜手术安全、可靠,是明确临床N2期肺癌纵隔淋巴结是否转移的有效方法。

Background and objective To determine the value of mediastinoscopy in the mediastinal staging of lung cancer with clinical N2 disease.Methods We retrospectively reviewed 87 patients received mediastinoscopy for known or suspected lung cancer,including 83 cervical mediastinoscopies and 4 parasternal mediastinoscopies.All patients were staged clinical N2 for enlarged ipsilateral mediastinal and/or subcarinal lymph nodes(short axis > 1.0 cm) on computed tomography scan.Results Of the 87 patients,61 cases pr...