电视纵隔镜与CT在胸部疾病诊断的临床应用

The clinical application of VM and CT in the diagnosis of thoracopathy

目的探讨电视纵隔镜检查与CT在纵隔疾病的诊断及术前肺癌N分期上的价值,并比较两种诊断方法之间的差别。方法回顾性分析临床行CT或PET-CT检查后诊断为纵隔疾病及高度怀疑为肺癌的患者68例的电视纵隔镜检查。纵隔疾病组的电视纵隔镜检查诊断与CT诊断相比较,判断术前术后的诊断符合率及CT的误诊率;以肺癌组行电视纵隔镜检查后病理报告为"金标准"推测电视纵隔镜及CT对肺癌纵隔淋巴结转移诊断的灵敏度、特异度、真实性、阳性预测值及阴性预测值,并比较电视纵隔镜与CT在肺癌纵隔淋巴结转移的诊断上有无差异性。结果①纵隔疾病组中电视纵隔镜检查术前术后的诊断符合率是55%(11/20),CT的误诊率是45%(9/20)。术前诊断为肺癌的病例组中,以41例病理报告确诊为肺癌的病例为样本推测电视纵隔镜检查对肺癌伴有纵隔淋巴结转移诊断的灵敏度93.3%,特异度100%,真实性97.6%,阳性预测值100%,阴性预测值96.3%;CT对肺癌伴有纵隔淋巴结转移诊断的灵敏度66.7%,特异度53.8%,真实性58.5%,阳性预测值45.5%,阴性预测值73.7%,电视纵隔镜检查的各项指标均高于CT,P<0.05(XC2=4.083),差异有显著性。②本研究组的手术并发症发生率2.94%(2/68),其中,1例为气胸,1例为喉返神经损伤。结论电视纵隔镜检查对纵隔疾病诊断及对术前肺癌N分期准确性高,优于CT;电视纵隔镜检查安全有效,在胸外科领域的发展前景广阔。

[Objective]To explore the value of VM （video mediastinoscopy） and CT in the diagnosis of mediastinal disease and N staging of preoperative lung cancer, and discuss the difference between the 2 methods. [Methods]68 cases of patients diagnosed as mediastinal disease or lung cancer by CT or PET-CT VM were analyzed. To the mediastinal disease patients, we compared the diagnosis from VM with which from CT to speculate the diagnose accordance rate and misdiagnosis rate of CT. To the lung cancer patients, the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM and CT were speculated according to the postoperative pathological reports, and the difference between VM and CT in the diagnosis of lung cancer with mediastinal lymphnodes metastasis was discussed.[Results]①In the mediastinal disease group, the diagnose accordance rate of CT after the examination of VM was 55% （11/20）, and the misdiagnosis rate of CT is 45% （9/20）. In the preoperative diagnosis of lung cancer group, 41 cases with final diagnosis of lung cancer were used as samples to speculate the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM. They were 93.3%, 100%, 97.6%, 100%, 96.3%, respectively, CT was 66.7%, 53.8%, 58.5%, 45.5%, 73.7%, respectively. The difference between VM and CT was statistically significant,P 0.05 （XC2=4.083）. ②In this group, the complications of VM incidence rate was 2.94% （2/68）, including 1 case of pneumothorax, 1 case of recurrent laryngeal nerve paralysis. [Conclusion]VM is superior to CT in the diagnosis of mediastinal disease and N staging of preoperative lung cancer, it is safe and effective, and there will be a wide perspective for VM in thoracic surgery.