纵隔镜在肺癌鉴别诊断和术前分期中的应用价值  

The Application of Mediastinoscopy in the Differential Diagnosis and Preoperative Staging on Lung Cancer

作　　者：毛锋[1] 张良[2] 蔡明辉[1] 丁征平[1] 申屠阳[1] 

机构地区：[1]上海交通大学附属胸科医院,上海市肺部肿瘤临床医学中心胸外科,上海200030 [2]吉林省肿瘤医院胸部肿瘤内科,长春130012

出　　处：《中国肺癌杂志》2014年第2期171-174,共4页Chinese Journal of Lung Cancer

摘　　要：背景与目的探讨纵隔镜检查术对纵隔肿物诊断和肺癌鉴别诊断/术前分期的临床应用价值。方法共计361例患者纳入研究,其中术前未确诊的纵隔肿物患者162例,疑诊或确诊肺癌并伴有纵隔淋巴结肿大(短径≥1.0 cm)患者199例。所有患者均接受手术,其中经颈纵隔镜检查术(SCM)308例,经胸骨旁纵隔镜检查术(PM)53例。结果①纵隔镜检查术对纵隔肿物诊断的准确性98.11%,敏感性97.62%,特异性100%,阳性预测值100%,阴性预测值91.67%。②纵隔镜检查术对肺癌纵隔淋巴结转移诊断的准确性98.28%,敏感性98.03%,特异性100%,阳性预测值100%,阴性预测值100%。手术相关并发症共计7例,发生率为1.93%。结论纵隔镜检查术创伤轻微、安全可靠、取材足量,对纵隔肿物的诊断价值极高,也是肺癌鉴别诊断和术前分期的重要方法和金标准。Background and objective To discuss the clinical application of mediastinoscopy in the differential di-agnosis and preoperative staging on lung cancer. Methods A total of 361 cases of patients were included in the study, of which 162 cases were undiagnosed mediastinal tumor patients before operation, and 199 patients were suspected or diagnosed with lung cancer or mediastinal lymph nodes enlargment（short diameter≥1.0 cm）. All patients underwent surgery, including 308 cases standard cervical mediastinoscopy （SCM） , 53 cases parasternal mediastinoscopy （PM）. Results Taking pathology diag-nosis as the gold standard, the mediastinoscopy diagnostic accuracy, sensitivity, speciifcity, positive predictive value, negative predictive value are 98.11%, 97.62%, 100%, 100%, 91.67%and 98.28%, 98.03%, a 100%, 100%, 100%to mediastinal masses and mediastinal lymph node metastasis of lung cancer. Total seven cases suffered from complications of surgery-related, the complication rate was 1.93 percent （P〈0.05）. Conclusion hTe trauma of the mediastinoscopy is slight, which is safe, reliable, able to take in suffcient tissue quantities. Mediastinoscopy is highly helpful not only in diagnostic of mediastinal mass, but also in the differential diagnosis of lung cancer, and it’s an important method and the gold standard of preoperative staging on lung cancer.

关 键 词：肺肿瘤 纵隔肿物 纵隔镜检查术 分期 诊断 

分 类 号：R734.2[医药卫生—肿瘤]