电视纵隔镜在胸部疾病诊疗中的应用体会

Clinical Application and Experience of Vedio-assisted Mediastinoscopy in the Diagnosis of Thoracic Disease

目的:探讨电视纵隔镜检查术(video-assisted mediastinoscopy,VAM)在胸部疾病诊断中的价值。方法:对2007年8月-2008年11月开展的15例电视纵隔镜手术的临床资料进行回顾分析。结果:本组病例手术时间40～90min,平均55min。术中出血10～100mL,平均48mL。12例患者术前临床诊断肺癌,区域淋巴结(N2,N3)肿大明显,为进行病理分期,进一步决定治疗方案行纵隔镜检查,7例病理检查阳性放弃开胸手术,5例阴性者开胸行根治性肺叶切除;纵隔疑难疾病3例,经纵隔镜手术后均明确诊断。本组病例术后无严重并发症发生,均顺利出院。结论:电视纵隔镜手术安全,简便易行,可作为纵隔疑难疾病诊断和鉴别诊断的有效方法,并为肺癌的准确分期提供病理依据。

Objective：To discuss clinical application of video-assisted mediastinoscopy in the diagnosis and therapy of thoracic disease. Methods：A total of fifteen standard cervical video-mediastinoscopy cases from August, 2007 to November, 2008 in our division were retrospectively reviewed. Results：The mean operation time was 55 min（range, 40~90 min）, mean blood loss was 48ml（range, 10~100 mL）. Twelve cases were with lung cancer which pre-operative radiological staging revealed mediastinal lymphadenopathy （N2 or N3）, 7 cases with positive pathological finding precluded curative surgery and 5 negative cases followed by radical lobectomies; Three additional cases were difficult-diagnosed mediastinal disease and obtained the definitive pathological diagnosis after VAM. No severe complications happened in our group. Conclusion：VAM is safe and effective procedure. It is helpful on diagnosis and differential diagnosis for noncausal mediastinal disease, and valuable to provide the pathological diagnosis for staging diagnosis of lung cancer.