电视纵隔镜在胸内淋巴结定性诊断中的应用

The Application of Video-assisted Mediastinoscopic in the Qualitative Diagnosis of Intrathoracic Lymph Nodes

目的:探讨如何利用电视纵隔镜对胸内淋巴结进行定性诊断的可能。方法:2008年5月～2011年8月复旦大学附属中山医院心外科开展电视纵隔镜对96例纵隔淋巴结进行了活检。其中66例纵隔淋巴结肿大患者合并有肺部肿块,术前经影像学诊断:T2期12例,T3期36例,T4期18例,M0期54例,M1期12例。30例单纯纵隔淋巴结肿大的患者术前经影像学检查无明显原发病灶。手术采用全身麻醉经颈部进行。结果:96例患者除2例发生纵隔感染外,无其他严重并发症发生,所有病例均明确诊断并康复出院。术后肺癌病理分期:T2N2M012例,T3N2M024例,T3N3M06例,T4N2M012例,T4N3M112例,单纯纵隔淋巴结肿大确诊为结节病18例;纵隔淋巴结癌转移6例,淋巴瘤6例。结论:电视纵隔镜手术安全、可靠,可明确肺癌患者的N分期及对纵隔疑难疾病作出诊断。

Objective： To investigate the clinical value of use the video-assisted mediastinoscope in the qualitative diagnosis of intrathoracic lymph nodes.Methods： Clinical data from 96 patients with simple mediastinal lymphadenopathy who underwent video-assisted mediastinoscopy between May 2008 and August 2011 were retrospectively analyzed in affiliated hospital of Nantong university.Among the patients,66 cases of mediastinal lymph nodes in patients with lung mass.By preoperative imaging diagnosis： 12 cases of T2 stage,36 cases of T3 stage,18 cases of T4 stage,54 cases of M0 period,12 cases of M1 period.30 cases were simple enlarged mediastinal lymph nodes of patients with preoperative no obvious primary lesion by imaging examination.Using general anesthesia with neck operation.Results： 96 patients except 2 case of mediastinal infection,no other serious complications,all cases were diagnosed clearly and rehabilitation hospital discharge.Postoperative pathological lung cancer stages： T2N2M012,T3N2M024,T3N3M06,T4N2M012,T4N3M112,18 cases of simple enlarged mediastinal lymph nodes diagnosed sarcoidosis.6 cases of Mediastinal lymph node cancer metastasis,6 cases of lymphoma.Conclusion： Video-assisted mediastinoscopy is safe and useful for the diagnosis of the mediastinal disease and N staging of lung cancer patients.