纵隔镜的诊断价值及在肺癌分期中的应用

The diagnostic value of mediastinoscopy and its application in staging for lung cancer

目的 探讨纵隔镜对纵隔肿瘤的诊断价值以及在肺癌分期中的应用。方法 41例患者接受了经颈纵隔镜检查术或 (和 )前纵隔切开术 ,其中纵隔肿瘤或不明原因淋巴结肿大 12例 ,临床怀疑为肺部恶性肿瘤 3例 ,肺癌治疗前纵隔淋巴结分期不明 2 6例。结果 12例纵隔肿瘤或纵隔不明原因的肿大淋巴结经颈纵隔镜或 (和 )前纵隔切开术后 ,经病理明确诊断为恶性胸腺瘤 1例、转移性肺癌 1例、转移性腺癌 1例、纵隔淋巴结淋巴滤泡增生 1例、成熟性畸胎瘤 1例、结节病 1例和肺炎性假瘤 1例 ,结核 3例 ,余 2例未能确诊 ;诊断符合率为 83.3%。 41例中有 3例临床怀疑为肺部肿瘤 ,经颈纵隔镜检查 1例诊断为结核 ;2例未能确诊 ,后经胸腔镜和剖胸探查诊断 ,1例为肺非霍奇金淋巴瘤 ,1例为肺炎性假瘤。2 6例肺癌纵隔镜诊断纵隔淋巴结转移的灵敏度为 87.5 % ,特异度为 10 0 %。全组术后切口感染 1例 ,无其他合并症。结论 纵隔镜对诊断纵隔肿瘤和对肺癌的分期安全准确。

Objective To evalute the value of mediastinoscopy in diagnosing unknown mediastinal disease and staging of lung cancers. Methods Form October 2000 to August 2001, 41 patients were examined by cervical mediastinoscopy with or without anterior mediastinotomy for diagnostic and staging purposes. Of these 41 patients, 12 were for diagnosis of unknown mediastinal disease, 3 for diagnosis and staging of pulmonary nodule or mass clinically suspected to be malignancy and 26 for the staging of lung cancer. Results Ten of 12 patients with unknown mediastinal disease were diagnosed pathologically as thymoma in 1, metastatic lesion from lung cancer in 1, metastatic thyroid carcinoma in l, lymph node hyperplasia in 1, teratoma in 1, sacoidosis in 1, inflammatory pseudotumor in 1 and tuberculosis in 3, giving a diagnostic rate of 83.3%. Of three patients with suspected malignancy, one was diagnosed as tuberculosis by cervical mediastinoscopy and the other two as lymphoma and pulmanory inflammatory pseudotumor by thoracoscopy and thoracotomy. The sensitivity and specificity of mediastinoscopy for the staging of mediastinal nodes in 26 lung cancers were 87.5% and 100%. Only one wound infection but no other major complication was found. Conclusion Mediastinoscopy is a safe procedure which can accurately provide information on diagnosis and staging.