自行组配电视纵隔镜诊断纵隔疑难病灶的临床价值  

Clinical Value of Self-assembled Video-mediastinoscopy in the Diagnosis of Undetermined Mediastinal Mass

作　　者：李斌[1,2] 张建华[1,2] 苟云久[1,2] 王志强[1,2] 王成[1,2] 宋铁牛[1,2] 杨建宝[1,2] 

机构地区：[1]兰州大学第二医院胸外科 [2]兰州大学第二临床医学院,兰州730030

出　　处：《中国微创外科杂志》2013年第11期969-973,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 总结应用自行组配电视纵隔镜行纵隔镜检查诊断纵隔疑难病灶的临床经验,探讨其应用价值,为缺少纵隔镜设备情况下如何整合现有微创资源开展纵隔镜检查术提供借鉴.方法 回顾性分析2007年11月～ 2013年3月127例电视纵隔镜手术的临床资料.其中2011年10月前应用直达喉镜、活检钳和10 mm 0.胸腔镜自行组配电视纵隔镜完成69例（自组配组）,2011年11月后应用Storz电视纵隔镜完成58例（Storz组）.结果 全组无手术死亡.2组手术时间无明显差异（P＞0.05）.并发出血3例（填塞压迫止血1例,开胸止血2例）,喉返神经损伤2例,并发症发生率3.9％,两组间差异无显著性[4.3％ （3/69） vs.3.4％ （2/58）,Х^2=0.000,P=1.000].自组配组明确病理诊断率98.6％（68/69）,Storz组100％（58/58）,两组差异无显著性（P=1.000）.9例术前合并上腔静脉综合征,其中7例同期经股静脉置入上腔静脉支架（自组配组4例,Storz组3例）,临床症状明显缓解.71例纵隔镜检查术前拟诊为恶性肿瘤,术后病理确诊为恶性肿瘤50例,良性病变21例,术前临床诊断准确率为70.4％ （50/71）;56例拟诊为良性病变,术后病理诊断良性病变37例,恶性肿瘤19例,术前临床诊断准确率66.1％（37/56）.结论 电视纵隔镜手术微创、安全,是纵隔疑难疾病诊断的可靠方法,利用现有器械和设备自行组配的电视纵隔镜系统,可用于纵隔疑难疾病的诊断.Objective To summarize our clinical experience of self-assembled video-mediastinoscopy in the diagnosis of mediastinal mass and to investigate their application value.Methods We retrospectively analyzed the clinical data of 127 patients with mediastinal mass undergoing video-mediastinoscopy for pathological study from November 2007 to March 2013.Sixty-nine patients underwent self-assembled video-mediastinoscopy （Self-assembled group,before October 2011,using direct laryngoscopy,biopsy forceps and 10 mm 0° thoracoscope） and 58 underwent Storz video-mediastinoscopy （Storz group,after November 2011）.Results No death occurred,and no significant statistical difference was found in the operation time between the two groups （P 〉 0.05）.Complications occurred in 5 cases （3.9%）,and no significant statistical significance was found between the two groups [4.3% （3/69） vs.3.4% （2/58）,Х^2 =0.000,P =1.000].The definite diagnostic rate was 98.6% （68/69） in the Self-assembled group,and 100% （58/58） in the Storz group without significant difference （P =1.000）.Of the 9 cases of being complicated with superior vena cava syndrome preoperatively,7 cases received the placement of endovascular stent （4 cases in Self-assembled group,3 cases in Storz group）,and their clinical symptoms were obviously relieved.Of the 71 patients diagnosed as malignant tumor before mediastinoscopy,pathological diagnosis showed there were malignant tumors in 50 cases and benign lesions in 21 cases,with a preoperative clinical diagnostic accuracy of 70.4% （50/71） ; of the 56 patients suspected of benign lesions,pathological diagnosis showed 37 cases of benign lesions and 19 cases of malignant lesions,with a preoperative diagnostic accuracy of 66.1% （37/56）.Conclusions Video-mediastinoscopy is a highly effective and safe procedure.Self-assembled video-mediastinoscopy can be used for the diagnosis of undetermined mediastinal mass.

关 键 词：纵隔镜 纵隔肿瘤 纵隔淋巴结肿大 并发症 诊断 

分 类 号：R734.5[医药卫生—肿瘤]