纵隔镜检查在胸部结节病诊断中的价值

The value of mediastinoscopy in the diagnosis of thoracic sarcoidosis

目的探讨纵隔镜检查术在胸部结节病诊断中的应用价值。方法回顾性分析北京大学人民医院胸外科自1999年11月至2004年6月,30例胸部影像学检查发现纵隔肿大淋巴结,但临床难以明确诊断,经纵隔镜检查术后确诊为结节病患者的临床资料。这些患者均经纵隔镜活检,获取气管周围、胸骨后、隆突下以及双侧肺门等部位的肿大淋巴结并送病理检查。结果本组患者术前诊断为恶性病变者17例,包括纵隔转移癌8例、肺癌6例、恶性淋巴瘤3例;良性病变者13例,包括结节病12例、纵隔淋巴结核1例。术后全部经病理证实为胸部结节病,其中I期24例,II期6例。术前术后诊断符合率40%(12/30),有57%(17/30)的患者术前误诊为恶性肿瘤,其中3例结节病患者因术前误诊肺癌或淋巴瘤,已在外院接受了化疗。30例患者均手术顺利,无手术死亡及并发症。结论纵隔镜检查术安全、可靠,对于I、II期胸部结节病是一种有效的诊断和鉴别诊断方法。

Objective To evaluate the role of mediastinoscopy in the diagnosis of thoracic sarcoidosis.Methods This study was retrospective.Mediastinoscopy was performed in a total of 30 patients who had enlarged mediastinal lymph nodes on chest CT and were clinically suspected of having sarcoidosis from November 1999 to June 2004.Biopsy tissues from peritracheal, retrosternal, subcarinal, or bilateral hilar regions were obtained for pathological study.Results All the patients had a definitive pathologic diagnosis, consisting of 24 cases of stage I and 6 stage II thoracic sarcoidosis.The diagnostic consistency between preoperation and postoperation was 40% (12/30), and the misdiagnosis rate preoperation was 60%(18/30).In this series, the initial diagnosis had been malignancy in17 cases(57%), of whom 3 had received chemotherapy at local hospitals.The overall incidences of postoperative complication and mortality were 0.Conclusion Our experience showed that mediastinoscopy is a valuable procedure which helps confirm the diagnosis of mediastinal disease.Given its safety and efficacy, it should be considered in the diagnosis and differential diagnosis of thoracic sarcoidosis of stage I or II.