纵隔疑难疾病的纵隔镜诊断和鉴别诊断

Mediastinoscopy for the diagnosis and differential diagnosis of undifferentiated mediastinal diseases.

目的 探讨纵隔镜手术在纵隔疑难疾病诊断中的应用价值。 方法 自 1999年 11月至2 0 0 2年 2月为 35例纵隔疑难疾病患者进行了纵隔镜手术 ,对胸部CT等检查发现的纵隔病变进行活检 ,获取气管周围、胸骨后、隆突下以及双侧肺门等部位的肿物组织送病检。 结果 本组除 1例外全部获得明确病理诊断 ,确诊率 97% (34/ 35 )。其中恶性病变 18例 (5 2 9% ) ,良性病变 16例 (47 1% )。术前术后诊断符合率 4 7 1% (16 / 34) ,术前误诊率 5 2 9%。术前误诊的病例中以良性病变多见 ,本组 16例良性病变中 ,有 6 2 5 % (10 / 16 )的病人术前误诊为恶性肿瘤。纵隔镜手术后发生声音嘶哑 1例 ,并发症发生率为 2 9% (1/ 35 )。无围手术期死亡。 结论 纵隔镜手术 ,可使一般方法难以确诊的纵隔疾病获得明确病理诊断 ,且具有创伤小、安全、取材可靠等优点 ,因此应作为纵隔疑难疾病诊断的常规手段。

Objective To evaluate the value of mediastinoscopy in the diagnosis of undifferentiated mediastinal diseases. Methods A total of 35 mediastinoscopies were performed for patients with undifferentiated mediastinal disease from November 1999 to February 2002 and suspicious tissues at peritracheal,retrosternal,subcarinal,or bilateral hilar areas were obtaiued for pathological examination. Results Thirty four of 35 patients with undetermined mediastinal diseases had definite pathologic diagnosis.The diagnosis accuracy was 97%(34/35).Of the 34 patients,18 were diagnosed as malignant accounting for 52.9%.Sixteen of the 34 were diagnosed as benign,accounting for 47.1%.The diagnostic consistency of preoperation and postoperation was 47.1%(16/34).The misdiagnosis of preoperation was 52.9%(18/34).In this series,the benigns were apt to lead to misdiagnosis.10 of 16 patients with benign disease were diagnoscd as initially malignancies,representing 62.5%.In the entire group one patient had complications (2.9%).Yet no perioperative death occurred. Conclusions Mediastinoscopy is a valuable procedure which helps mede a correct diagnosis of mediastinal diseases.Given its safety and usefulness It is suggested that mediastinoscopy should be used routinely in the diagnosis of undifferentiated mediastinal diseases.