经颈部纵隔镜检查在胸部疾病诊断中的价值

Cervical Mediastinoscopy for Diagnosis of Thoracic Diseases in 281 Patients

目的探讨经颈部纵隔镜检查术在胸部疾病诊断中的价值。方法回顾性分析1990年1月-2008年9月施行281例经颈部纵隔镜检查术的临床资料。采用局部浸润麻醉或全身麻醉,经气管前间隙向下方探查气管周围肿物和淋巴结,并进行活检。结果268例获得明确病理诊断,确诊率95.4%（268/281）。术前诊断不明23例全部获得明确病理诊断,恶性肿瘤术前诊断病理符合率56.9%（41/72）,良性病变术前诊断病理符合率87.4%（104/119）。结论经颈部纵隔镜检查术对单独或伴有纵隔内肿块的胸部疾病是一种有效的检查方法,对于诊断不明的单纯纵隔淋巴结肿大者尤其适合,对肺癌伴有纵隔淋巴结肿大或纵隔肿瘤者可选择应用。

Objective To investigate the value of cervical mediastinoscopy （CM） in the diagnosis of thoracic diseases. Methods From January 1990 to September 2008 , 281 patients with diseases in the chest were examined by cervical mediastinoscopy under local infiltration anesthesia or general anesthesia. Through the pretracheal space, exploration and biopsy of the neoplasms and lymph nodes around the trachea were carried out. Results Among the cases, pathological diagnosis were made in 268 patients （95.4%） , including the 23 patients who were not clearly diagnosed before the operation. The accuracy of the preoperative diagnosis was 56.9% （41/72） for malignant tumors, and 87.4% （104/119） for benign lesions. Conclusions Cervical mediastinoscopy is an effective method to detect mediastinum diseases with or without other thoracic diseases, especially for simply enlarged lymph nodes in the mediastinum. For the patients with lung cancer complicated with enlarged lymph nodes in the mediastinum or those with tumors in the mediastinum, the method is also feasible.