电视纵隔镜在胸部疾病中的应用体会

Video-mediastinoscopy in the Experience of Chest Diseases

目的:探讨电视纵隔镜检查术(video-mediastinoscopy,VM)在肺癌(无肺癌根治术指征者)、纵隔肿物和恶性胸腔积液诊断中的应用价值。方法:采用全麻并气管插管,71例经胸骨上窝纵隔镜活检术,40例经胸骨旁纵隔镜检查术,49例经肋间纵隔镜手术。结果:160例经VM术后确诊肺鳞癌41例、肺腺癌39例、肺小细胞癌9例、肺大细胞癌1例、腺鳞癌2例、淋巴结炎症9例、淋巴结核12例、结核性胸膜炎4例、胸腺癌4例、非霍奇金淋巴瘤4例、霍奇金淋巴瘤3例、心包囊肿1例、胸膜间皮瘤5例、纵隔神经母细胞瘤3例、纵隔纤维肉瘤1例、胸腺瘤5例、后纵隔神经鞘瘤3例、结节病13例、胸腺增生1例;术中发生出血2例,结核切口延迟愈合和切口感染各1例。结论:VM不但是部分肺癌、纵隔疾病的重要检查方法,也是诊治恶性胸腔积液的首选方法。

Objective：To study the application of video-mediastinoscopy in lung cancer without operative indication and the diagnosis and treatment of mediastinal tumors or malignant pleural effusion.Methods： Video-mediastinoscopy was performed in 160 cases under general anesthesia and single lumen endotracheal intubation,including 71 cases of cervical mediastinoscopy,40 cases of parasternal mediastinoscopy,and 49 cases of intercostal mediastinoscopy.Results： The diagnosis was clarified under video-mediastinoscopy in 160 cases,including 39 cases of adenocarcinoma,41 cases of squamous cell carcinoma,9 cases of small cell carcinoma,1case of large cell lung carcinoma,2 cases of adenosquamous carcinoma,12 cases of node tuberculosis,9 cases of lymph node inflammation,4 cases of tuberculous pleuritis,4 cases of carcinoma of the thymus,4 cases of non-Hodgkin＇s lymphoma,3 cases of Hodgkin＇s lymphoma,1 case of pericardial cyst,5 cases of pleural mesothelioma,3 cases of neuroblastoma,1 case of mediastinal fibrosarcoma,5 cases of thymoma,3 cases of postmediastinum neurilemmoma,13 cases of sarcoidosis,1 case of hyperplasia of thymus.Complications included 2 cases of hemorrhage,1 case of superficial incision infection and 1 tuberculosis incision delayed union.Conclusions： Video-mediastinoscopy is not only an important ways of diagnosis for lung cancer without operative indication and massive mediastinal diseases but also treatment malignant pleural effusion.