电视纵隔镜对纵隔疑难病灶诊断的临床价值  

Clinical value of videomediastinoscopy in diagnosis of mediastinal disease

作　　者：彭忠民[1] 刘奇[1] 陈景寒[1] 孟龙[1] 杜贾军[1] 王磊[1] 张林[1] 王晓航[1] 

机构地区：[1]山东省立医院胸外科,济南250021

出　　处：《中华医学杂志》2006年第20期1414-1416,共3页National Medical Journal of China

基　　金：山东省优秀中青年科学基金资助项目(2004BS03018)

摘　　要：目的探讨电视纵隔镜在纵隔疑难病灶诊断中的应用价值。方法回顾性分析我院行电视纵隔镜检查的115例患者,其中颈部纵隔镜手术102例,胸骨旁纵隔镜手术13例,手术在全麻或局麻下完成。单纯纵隔病灶诊断不明的患者91例,高度怀疑肺癌或明确为非小细胞肺癌伴有纵隔淋巴结肿大的患者25例。结果纵隔病灶活检确诊为结节病者37例,结核14例,淋巴瘤15例,原因不明的纵隔转移癌18例,无干酪性坏死又无典型“结节细胞”的肉芽肿6例,疾病确诊率为93.3%(84/90);肺癌诊断分期25例,准确率为100%(25/25)。电视纵隔镜总的诊断正确率为94.8%(109/115),CT为56.5%(65/115)。本组患者平均手术时间26min,无手术并发症及病死率。结论对于纵隔疑难病灶的诊断或肺癌分期,电视纵隔镜检查准确率高且安全可行。Objective To evaluate the role of videomediastinoscopy in the diagnosis of disease of the mediastinum. Methods We retrospectively reviewed the clinical records of the 115 patients who underwent videomediastinoscopy. Local anesthesia or general anesthesia was employed. This operation consisted of cervical videomediastinoscopy in 102 patients, parasternal videomediastinoscopy in 13 patients. ninety-one patients had videomediastinoscopy for diagnosis of isolated mediastinal mass or lymphadenopathy, 25 patients with non small cell lung cancer or suspected lung cancer showed enlarged mediastinal lymph nodes radiographically in the chest. Results Among the patients with mediastinal disease, sarcoidosis was diagnosed in 37 patients, tuberculosis in 14 patients, lymphoma in 15 patients, nodal metastasis in 18 patients, noncaseating granulomata without classical ＂sarcoid＂ in 6 patients, with the accuracy of 93.3% （84/90）; and staging of lung cancer in 25 patients, with the accuracy of 100% （25/25）. The total accuracy of videomediastinoscoy and CT was 94.8% （109/115） , 56.5% （65/115）, respectively. Mean operative time was 26 min. There was neither complication nor mortality. Conclusion videomediastinoscopy is a safe and effective procedure for the diagnosis of mediastinal disease and the staging of lung cancer.

关 键 词：电视纵隔镜 纵隔疾病 癌 非小细胞肺 诊断 分期 

分 类 号：R655.5[医药卫生—外科学] R737.26[医药卫生—临床医学]