电视纵隔镜临床应用的初步体会

Preliminary experience of video-mediastinoscopy in clinical application

目的 探讨电视纵隔镜手术在临床应用中的价值。 方法 回顾性总结 2 0 0 1年 9月～ 2 0 0 2年 9月 54例经电视纵隔镜手术患者的临床资料 ,其中颈部纵隔镜手术 44例 ,胸骨旁纵隔镜手术 6例 ,颈部加胸骨旁纵隔镜手术 4例。术前未获得明确病理诊断的纵隔疾病 1 8例 ;高度怀疑或已明确诊断为肺癌且影像学显示纵隔淋巴结肿大 (直径 >1 0cm)者 36例。 结果 术前未获病理诊断的 1 8例患者 ,经电视纵隔镜检查后 1 7例取得明确诊断 ,确诊率为 94 4% (1 7/ 1 8) ;高度怀疑或病理已确诊为肺癌的 36例 ,电视纵隔镜检查证实肿瘤纵隔淋巴结转移 (阳性 ) 2 2例 ,未见纵隔淋巴结转移 (阴性 ) 1 4例。阳性者放弃手术 ,予以化疗。阴性者均中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫。术后病理证实肺癌 1 1例 (纵隔淋巴结未见转移 ,与纵隔镜检查结果相符 ) ,肺结核球、炎性假瘤和错构瘤各 1例。本组纵隔镜手术后患者并发症发生率及病死率均为 0。 结论 电视纵隔镜手术更安全、可靠 。

Objective To determine the value of video mediastinoscopy in clinical application. Methods The clinical data of 54 patients receiving video mediastinoscopy were reviewed retrospectively. This operation consisted of cervical mediastinoscopy in 44 patients, parasternal mediastinoscopy in 6, and combined procedures in 4. Of these patients, 18 underwent video medaistinoscopy for the evaluation of undifferentiated mediastinal disease. Thirty six patients with suspected lung cancer showed enlarged mediastinal lymph nodes radiographically in the chest and underwent video medaistinoscopy. Results Seventeen of 18 patients with undetermined mediastinal diseases had a definitive pathologic diagnosis, with an accuracy of 94 4%(17/18). In the 36 patients with suspected lung cancer, 22 were positive, and 14 negative. In the negative patients who underwent thoracotomy with resection, mediastinal lymph nodes revealed no evidence of metastasis. There were no postoperative complication and deaths. Conclusion Video mediastinoscopy as a highly effective and safe procedure could be used in the diagnosis and staging of thoracic diseases.