电视纵隔镜技术在纵隔病变临床诊断中的应用及体会

Clinical application and diagnosis value of video-assisted mediastinoscopy on mediastinal disease

目的探讨电视纵隔镜技术对诊断疑难纵隔疾病或胸部病变累及纵隔淋巴结时的临床应用价值。方法分析我科行纵隔镜检查术的50例患者,本组病例术前均行胸部CT、细胞学相关检查,其中9例行PET/CT检查,5例行EBUS-TBNA检查,将纵隔镜检查手术前后诊断符合率进行对比分析。结果术前相关检查中恶性24例,良性26例,所有病例均成功取得或切除目标组织,最终病理结果恶性19例,良性31例,经对比分析,影像学及细胞学等检查确诊率为61.53%,误诊率38.47%。全组无手术死亡病例,术中出血1例,成功压迫止血,术后颈部切口感染1例,经换药后愈合良好。结论影像学及细胞学等检查在纵隔疾病的诊断中,存在一定的误诊率,纵隔镜检查是获得病理诊断的最佳途径,确诊率较高,该技术安全有效。

Objective To discuss the clinical application and diagnosis value of video-assisted mediastinoscopy on mediastinal disease. Methods 50 patients were given video-assisted mediastinoscop from June 2012 to June2014. All patients proceeded chest CT and cytology examination,including 9 cases with PET / CT and 5 cases with EBUS-TBNA. The diagnostic coincidence before and after VAM were analyzed. Results There were 24 moderatemalignant cases and 26 benign cases by related examinations before surgery. All patients＇ surgery was successful.And finally there were 19 malignant cases and 31 benign cases through pathological examination after surgery. The diagnostic rate of imaging and cytological examination was 61. 53%,and the mis-diagnostic rate was 38. 47%. There was no death reported during surgery,and 1 case had bleeding during surgery. Conclusion Mediastinoscopy is the best way to obtain pathologic diagnosis,and its diagnostic rate is higher,with the advantages of high safety,effectiveness and easy operation.