纵隔镜检查手术并发症12例报告

Complications of mediastinoscopic examinations: Report of 12 cases

目的探讨纵隔镜检查手术并发症的原因、预防和治疗。方法回顾分析1981年9月～2005年11月我院262例纵隔镜检查中12例发生并发症的临床资料。结果术中无名动脉的小分支大出血1例,经扩大颈部切口,纱布填塞压迫止血2h后止血。切口感染5例:1例为肺结核,纵隔淋巴结肿大、中央坏死,活检造成溃破,经切开、引流、换药后切口愈合;4例简单换药后愈合。声音嘶哑2例,未特殊处理,分别于术后1、3个月明显好转。心电图异常2例,西地兰处理后好转。气胸2例,未特殊处理,分别于术后4、6d自愈。结论在熟悉纵隔解剖、操作轻柔的基础上,才能更好的防止纵隔镜检查术的并发症。

Objective To discuss the causes, prophylaxis, and treatment of the complications of mediastinoscopy. Methods Mediastinoscopy was performed in 262 consecutive patients from September 1981 to November 2005 in this hospital. Of them, 12 patients experienced preoperative or postoperative complications. Results During the operation, massive hemorrhage from branches of the innominate artery occurred in 1 patient. After the extension of cervical incision, the bleeding was stopped by pressure tamponade for 2 hours. Wound infection happened in 5 patients. One patient was clarified as having pulmonary tuberculosis, with enlargement and necrosis of mediastinal lymph nodes that led to the diabrosis of biopsy passage. The wound infection was cured by cut- open, drainage, and dressing changes. Wound infection in another 4 patients healed after dressing changes. Hoarseness of voice developed in 2 patients and spontaneously subsided at 1 and 3 postoperative months respectively. Two patients with abnormal electrocardiogram were treated with cedilanid. Pneumothorax was found in 2 patients and spontaneously healed at 4 - 6 days after operation. Conclusions Complications of mediastinoscopy can be avoided in experienced hands, on the basis of proficiency of mediastinal anatomy and careful surgical manipulation.