纵隔镜检查术的临床应用

Application of mediastinoscopy in diagnosis of mediastinal disease and staging of lung cancer

目的探讨纵隔镜检查术在胸部疾病诊断和肺癌分期中的价值。方法对2004年8月至2005年8月,有选择性地对施行纵隔镜检查术的52例患者的临床资料进行回顾性分析。所有患者均采用全麻单腔插管,术中经气管前间隙向下方探查气管周围肿物和淋巴结,并进行活检。结果51例符合诊断；1例未获取淋巴结组织而未能明确诊断,诊断符合率为98．1%。31例纵隔疑难病例中,明确诊断30例,诊断符合率为96．8%。21例肺癌或疑似肺癌伴有纵隔淋巴结肿大者中,16例纵隔淋巴结阳性的肺癌患者避免了开胸手术,5例纵隔淋巴结阴性者均中转开胸行肺叶切除联合纵隔淋巴结清扫,大体标本病理证实均为肺癌,术中清扫的纵隔淋巴结均经病理证实未见肺癌转移,与纵隔镜检查结果相符,诊断符合率为100．0%。结论对于累及纵隔淋巴结的疾病或紧邻纵隔的胸部疾病,纵隔镜检查术是一种有效的检查方法,对于诊断不明的单纯纵隔淋巴结肿大者尤其适合；对于肺癌或疑似肺癌伴有纵隔淋巴结肿大的患者其可选择使用在临床诊断和肿瘤分期上。

Objectives To appraise the value of mediastinoscopy in diagnosis of thoracic diseases and staging of lung cancer. Methods From August 2004 to August 2005, 52 cases accepted mediastinoscopy with biopsy of neoplasm and peritracheal lymph nodes through pretracheal interstice. Results The diagnosis of 52 cases but one by mediastinoscopy was consistent with the pathologic diagnosis. The concordance diagnostic rate was 98. 1% （51/ 52）. Among 31 difficult diagnostic cases of mediastinal disease by other methods, 30 cases were diagnosed by mediastinoscopy with concordance diagnostic rate of 96.8% and 16 lung cancers were confirmed with metastasis to the mediastinum thereby spared exploratory thoractomy; and the rest accepted thoractomy. The lymph nodes in the mediastinium were pathologically diagnosed as positive metastasis. The concordant diagnostic rate by mediastinoscopy reached 100%. Conclusions Mediastinoscopy is an effective method for diagnosing diseases involving mediastinal lymph nodes, especially shoud be the first choice for diagnosing or staging lung cancer with enlarged mediastihal lymph nodes or those with mediastinal tumor.