应用纵隔镜手术诊断Ⅰ期胸部结节病

Value of mediastinoscopy in the diagnosis of stage I thoracic sarcoidosis

目的探讨纵隔镜手术在Ⅰ期胸部结节病诊断和鉴别诊断中的应用价值。方法回顾性分析1999年11月至2007年6月60例临床拟诊Ⅰ期胸部结节病患者的临床资料。所有患者术前行胸部X线片及CT发现肺门和（或）纵隔淋巴结肿大，肺部未见异常表现。以伴有或不伴有纵隔淋巴结肿大的两侧肺门淋巴结肿大为Ⅰ期胸部结节病的典型表现。结果本组60例患者术后均获得明确的病理诊断。影像学表现典型者33例，纵隔镜检查术后32例获得病理学证实，诊断准确率97％；1例为纵隔淋巴结反应性增生。27例根据影像学表现考虑不典型Ⅰ期胸部结节病的患者，纵隔镜检查术后病理证实17例（63％），另有纵隔淋巴结结核6例，纵隔淋巴结反应性增生2例，转移性鳞状细胞癌以及小细胞癌各1例。全组手术顺利，无手术死亡及并发症。结论临床及影像学表现典型的Ⅰ期胸部结节病，其临床诊断准确率高，一般不需要行纵隔镜等有创检查以获得病理学证实。

Objective To determine the current role of mediastinoscopy in the diagnosis and differential diagnosis of stage Ⅰ thoracic sarcoidosis. Methods The clinical data of 60 patients with a presumptive diagnosis of stage Ⅰ thoracic sarcoidosis underwent mediastinoscopy from November 1999 to June 2007 were analyzed retrospectively. All the patients had hilum of lung and/or mediastinal lymphadenopathy with normal lung parenchyma on thoracic CT scan. Typical stage Ⅰ sarcoidosis was defined as presence of bilateral hilum of lung lymphadenopathy with/without mediastinal lymphadenopathy. Results All the patients had definitive pathologic diagnosis. Among the 33 patients with typical presentation of stage Ⅰ sarcoidosis, 32 patients were confirmed by pathology. One patient was reactive lymph node. Among the 27 patients with atypical patterns on CT, 17 patients were confirmed by pathology. No postoperative complication and mortality occurred. Conclusion For the patient with a presumptive diagnosis of typical stage Ⅰ thoracic sarcoidosis after clinical and radiological evaluation, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.