经颈部纵隔镜手术在肺癌诊断中的应用

The application of cervical mediastinoscopy in diagnosis of lung canner

目的:探讨纵隔镜检查在肺癌诊断中的应用价值和临床经验。方法:对258例初步诊断或疑诊肺癌的患者行纵隔镜淋巴结活检并将标本送病理检查,根据病理报告对疾病作出明确诊断。结果:全部病例中获得明确病理诊断者245例,确诊率95.0%(245/258)。术前检查确诊为肺癌并纵隔淋巴结转移的67例患者中,纵隔淋巴结阳性49例,阴性18例,CT检查准确率73.1%(49/67);术前拟诊为恶性肿瘤72例患者中,术后病理确诊为恶性肿瘤41例(其中肺癌24例,纵隔恶性肿瘤17例),良性疾病25例,术后诊断不明6例,术前诊断准确率为56.9%(41/72);术前拟诊为良性疾病119例患者中,术后病理诊断为良性疾病104例(其中结节病74例,纵隔淋巴结结核15例,纵隔淋巴结炎15例),恶性疾病(肺癌)8例,术后诊断不明7例,术前诊断准确率为87.4%(104/119)。结论:在肺癌诊断及肺癌术前分期方面,纵隔镜检查是一种准确、安全、可靠的有效方法。

Objective： To explore the application value and summarize the clinical experience of mediastinoseopy examination in the diagnosis of lung cancer. Methods： 258 patients cases of initial diagnosis or suspected diagnosis of lung cancer were done mediastinal lymph node biopsy with mediastinoscopy. Then the specimens were sent to pathology, a clear diagnosis of disease would be made according to the pathological report. Results：Of the 258 lung cancer patients diagnosed or diagnosed doubtfully, 245 patients were diagnosed definitely by mediastinoscopy, accurate rate was 95.0% （245/258）. of the 67 lung cancer patients with definite diagnosis, the mediastinal lymph nodes of 49 patients were metastesis and no metastasis nodes in the others ,the positive rate of CT was 73.1% （49/67）; In the 72 preoperative patients diagnosed as malignant tumor doubtfully , 41 cases of malignant tumors （24 cases of lung cancer, 17 cases of mediastinal malignant tumor）,25 cases of benign disease, 6 cases of unexplained diagnosis were confirmed by postoperative pathology. Preoperative diagnostic accuracy was 56.9% （41/72）; In the 119 preoperative patients cases diagnosed as benign disease, 104 cases of benign disease （74 cases of sarcoidosis, 15 cases of mediastinal lymph node tuberculosis, 15 cases of mediastinal lymphadenitis）, 8 eases of malignant diseases （lung cancer）, 7 cases of unknown diagnosis were confirmed by postoperative pathology. Preoperative diagnostic accuracy was 87.4% （104/119）. Conclusion：The mediastinoscopy is an accurate, safe, reliable and effective method in the lung cancer diagnosis and preoperative staging of lung cancer.