电视纵隔镜手术在胸部疾病诊断中的价值  

Diagnostic value of video-mediastinoscopy for thoracic diseases

作　　者：阮英定 李建新[2] 由茂端[2] 薛洪省[2] 许剑扬[2] 赵志龙[2] Ruan Yingding;Li Jianxing;You Maoduan;Xue Hongsheng;Xu Jianyang;Zhao Zhilong(Dalian Medical University,Dalian 116044,China;Department of Thoracic Surgery,Zhongshan Hospital Affiliated to Dalian University,Dalian 116001,China)

机构地区：[1]大连医科大学,116044 [2]大连大学附属中山医院胸外科,116001

出　　处：《中华胸部外科电子杂志》2018年第4期219-224,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的探讨电视纵隔镜手术(VMS)对胸部疾病的诊断价值及学习曲线。方法收集2009年1月至2018年6月,大连大学附属中山医院胸外科同一手术组连续完成的111例VMS患者的临床资料。其中纵隔淋巴结肿大患者96例,依照手术先后顺序分为A、B、C、D四组,每组24例;根据每组患者术中出血量、手术时间、并发症发生率和术后住院时间,计算VMS的学习曲线。结果 111例VMS患者中,4例纵隔淋巴结肿大患者术后未获明确诊断,VMS的确诊率为96.4%(107/111)。8例胸腔积液和7例纵隔肿物均获得明确诊断。手术并发症发生率为9.0%,包括术中无名动脉出血1例、术后喉返神经暂时麻痹1例、切口延期愈合7例,术后因晚期肺癌大咯血死亡1例。针对60例患者肺癌纵隔分期,54例发现纵隔淋巴结转移,6例阴性患者经肺癌根治术得到证实,VMS肺癌纵隔分期的敏感度、特异度、阳性预测值、阴性预测值和准确率均为100%。A组和B组患者的出血量分别为(26.3±32.9)ml和(34.1±101.6)ml,明显多于C组和D组的(6.6±10.0)ml和(8.6±9.4)ml,四组间差异有统计学意义(P=0.004);但四组患者的手术时间、术后并发症发生率和住院时间比较,差异均无统计学意义(P>0.05)。结论在肺癌分期、胸部疾病诊断等方面,VMS是安全、微创且可靠的,临床医师应用VMS进行纵隔淋巴结活检的学习曲线为24～48例。Objective To investigate the diagnostic value and learning curve of video-mediastinoscopy（VMS） for thoracic diseases.Methods Clinical data of 111 patients undergoing VMS in the same operative group in the department of thoracic surgery from January 2009 to June 2018 were retrospectively analyzed. Among them, 96 patients with mediastinal lymphadenopathy were divided into groups A, B, C and D according to the sequence of operation, 24 in each group. The learning curve of VMS was calculated according to the amount of bleeding, operative time, perioperative morbidities, postoperative hospital stay, etc.Results Among 111 cases of VMS, only 4 cases of mediastinal lymphadenopathy were not diagnosed clearly after operation, and the diagnostic rate of VMS was 96.4% （107/111）. 8 cases of pleural effusion and 7 cases of mediastinal tumors were definitely diagnosed.The overall incidence of surgical complications was 9.0%, including 1 case of intraoperative bleeding from arteriae anonyma, 1 case of transient recurrent laryngeal nerve paralysis, 7 cases of delayed healing of incision, and 1 case of postoperative death from massive hemoptysis due to advanced lung cancer （0.9%） . After mediastinal staging in 60 patients with lung cancer, 54 patients found mediastinal lymph node metastasis, and 6 negative patients were confirmed by radical resection. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VMS were all 100% for mediastinal staging in lung cancer. In terms of bleeding volume, group A （26.3±32.9） ml and group B （34.1±101.6） ml were significantly more than group C （6.6±10.0） ml and group D （8.6±9.4） ml. The differences between the four groups were statistically significant （ P =0.004）. However,there was no significant difference in operative time, perioperative morbidities and postoperative hospital stay （ P 〉0.05）.Conclusions VMS is safe, minimally invasive and reliable in staging lung cancer and diagnosis of thoracic disease

关 键 词：电视纵隔镜 胸部疾病 纵隔淋巴结 学习曲线 

分 类 号：R655[医药卫生—外科学]