电视纵隔镜手术128例

Video-mediastinoscopy: Report of 128 cases

目的探讨电视纵隔镜检查术(video-m ed iastinoscopy,VM)在肺癌术前分期、纵隔肿物诊断和恶性胸腔积液诊治中的价值。方法采用全麻单腔螺纹气管插管,48例行颈部纵隔镜术,33例行胸骨旁纵隔镜检查术,47例行经肋间纵隔镜术。结果125例经电视纵隔镜术后确诊:肺腺癌38例,肺转移性低分化鳞癌33例,结核9例,淋巴结炎症8例,肺小细胞癌7例,胸腺鳞状细胞癌6例,非霍奇金淋巴瘤5例,纵隔神经母细胞瘤4例,胸腺瘤4例,胸膜间皮瘤3例,霍奇金淋巴瘤2例,后纵隔神经鞘瘤2例,结节病1例,胸腺增生1例,类癌1例,中纵隔原始神经外胚叶肿瘤1例。1例电视纵隔镜检查纵隔淋巴结为反应性增生,行左下肺叶切除,病理为鳞癌。2例术前纤维支气管镜病理确诊左下肺鳞癌,电视纵隔镜检查右气管旁淋巴结转移。术中发生气胸1例、出血1例、喉返神经麻痹和切口感染各2例。结论电视纵隔镜术不但是肺癌术前病理分期、纵隔疾病的重要检查方法,而且也是诊治恶性胸腔积液的简便方法。

Objective To study the application of video-mediastinoscopy in the preoperative staging of lung cancer and the diagnosis and treatment of mediastinal tumors or malignant pleural effusion. Methods Video-mediastinoscopy was performed in 128 cases under general anesthesia and single lumen endotracheal intubation, including 48 cases of cervical mediastinoscopy, 33 cases of parasternal mediastinoscopy, and 47 cases of intercostal mediastinoscopy. Results The diagnosis was clarified under video- mediastinoscopy in 125 cases, including 38 cases of adenocarcinoma, 33 cases of metastatic squamous cell carcinoma, 9 cases of tuberculosis, 8 cases of lymph node inflammation, 7 cases of small cell carcinoma, 6 cases of squamous cell carcinoma of the thymus, 5 cases of non-Hodgkin＇s lymphoma, 4 cases of neuroblastoma, 4 cases of thymoma, 3 cases of pleural mesothelioma, 2 cases of Hodgkin＇s lymphoma, 2 cases of neurilemmoma, 1 case of sarcoidosis, 1 case of hyperplasia of thymus gland, 1 case of careinoid, and 1 case of primitive neuro-ectodermal tumor. In 1 case, the mediastinal lymph nodes were diagnosed as reactive hyperplasia by video-mediastinoscopy, and then were confirmed as squamous cell carcinoma by postoperative pathological examination. Two cases were confirmatively diagnosed as having lung cancer in the left inferior lobe by brochoscopy, and video-mediastinoscopy revealed the metastasis to right paratracheal lymph nodes. Complications included 1 case of pneumothorax, 1 case of hemorrhage, 2 cases of recurrent laryngeal nerve paralysis, and 2 cases of superficial incision infection. ConcIusions Video-mediastinoscopy is not only an important examination for preoperative staging of lung cancer and diagnosis of mediastinal diseases, but also a surgical treatment for mediastinal tumors and malignant pleural effusion.