电视纵隔镜在胸部疾病诊断中的初步体会

Preliminary experience of video-mediastinoscopy in the diagnosis of thoracic diseases

目的探讨电视纵隔镜对胸部疾病诊断价值。方法38例患者接受了经颈纵隔镜检查术,术前未获得明确病理诊断的纵隔疑难疾病16例,高度怀疑为肺部恶性肿瘤3例,已明确诊断肺癌且影象学显示纵隔淋巴结肿大(≥1.0cm)19例。结果16例纵隔肿瘤或纵隔不明原因的肿大淋巴结经颈纵隔镜后经病理明确诊断为:结核3例,恶性胸腺瘤2例、纵隔淋巴结淋巴滤泡增生2例、肺炎性假瘤2例,转移性肺癌1例、转移性甲状腺癌1例、成熟性畸胎瘤1例、结节病1例和肺炎性假瘤1例,余2例未能确诊;诊断符合率为87.5%。3例临床怀疑为肺部肿瘤,经颈纵隔镜检查1例诊断为结核;2例未能确诊,后经胸腔镜和剖胸探查诊断,1例为肺非霍奇金淋巴瘤,1例为肺炎性假瘤。19例肺癌纵隔镜诊断纵隔淋巴结转移的灵敏度为86.4%,特异度为100%。全组术后出血1例,无其他合并症。结论纵隔镜对诊断纵隔肿瘤和对肺癌的分期安全准确。

Objective To determine the value of wideo-mediastinoscopy inthoracic diseases.Methods 38 patients were examined by cervial mediastinoscopy with video-mediastinosopy for diagnostic and staging purposes. Of these 38 patients, 16 were for diagnosis of unknown medlastinal disease,3 for diagnosis and staging of pulmonary no dule or mass clinically suspected to be malignancy and 19 for the staging of lung cancer and images show mediastinally lymphadenectasis （ ≥1.0 era）. Results 16 patients with unknown mediastinal as tuberculosis in 3, thymoma in 2, in flammatory pseudo tumor in 2, lymph node hyperplasia in 1, metastaticlesion from lung cancer in 1, metastatic thyroid carcinoma in 1, teratoma in 1, and sacoidosis in 1. giving a diagnosticrate of 87.5 %. Of three patients with suspected malignancy,one was diagnosed as tuberculosis by cervical mediastinoscopy and the other two as lymphoma and pulmanory inflammatory pseudo tumor by thoracoscopy and thoracotomy. Theseusitivity and specificity of mediastinoscopy for the staging of mediasfinal no desin 19 lung cancerswere 87.5% and 100%. Only one haemorrhaged but no other majorcomplicafion was found. Conclusion Mediastioscopy is a safe procedure which can accurately provide in formation on diabnosis and staging.