纵隔淋巴结肿大21例临床观察

Clinical observation of 21 patients with mediastinal lymphadenopathy

目的结合纵隔淋巴结肿大的诊断、鉴别诊断及治疗情况,探讨良恶性纵隔淋巴结肿大的诊治特点。方法收集我院2001年12月至2009年6月纵隔淋巴结肿大、临床诊断不明的21例患者,均行手术获取病变组织,经病理检查确诊并指导治疗。结果 21例患者术前影像及临床初步诊断大多数考虑为恶性疾病。行剖胸探查6例,胸腔镜手术8例,纵隔镜手术7例。术后病理证实恶性淋巴瘤6例、中央型肺癌伴纵隔淋巴结转移3例、恶性胸腺瘤1例、结节病4例、纵隔淋巴结结核5例、Castleman病1例、性质不明1例。结论对于纵隔区域发现的难定性肿大淋巴结,治疗前应尽可能获取明确的病理诊断。胸腔镜或纵隔镜检查是针对纵隔淋巴结肿大很有价值的确诊和治疗手段。

Objective To explore the diagnosis and treatment for mediastinal lymphadenopathy. Methods Twenty-one patients with mediastinal disease underwent the operation from December 2001 to June 2009 were collected. The clinical presentation, histopathology and treatment were obtained. Results Among the patients, 6 patients had exploratory thoraeotomy, 8 patients had tho- raeoscopy, 7 patients had mediastinoscopy. Pathologic diagnoses were 6 cases malignant lymphoma, 3 cases central type lung cancer with mediastinal lymph metastasis, 1 case malignant thymic tumors, 4 cases sarcoidosis, 5 cases mediastinal tuberculous lymphadenitis, 1 case Castleman and 1 case was difficult to be recognized. These diseases and the enlargement of mediastinal lymph nodes for so- meother reasons were hard to be differentiated by imaging. Thus they were easily resulted in misdiagnosis. Conclusion Thoracoscopy or mediastinoscopy proved to be a valuable device for diagnosis and treatment of mediastinal lymphadenopatly.