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目的 探讨纵隔镜手术在胸部疾病及肺癌分期中的应用价值。 方法 71例患者行纵隔镜手术 ,其中颈部纵隔镜手术 5 5例 ,胸骨旁纵隔镜手术 12例 ,颈部加胸骨旁纵隔镜手术 4例。术前未获得明确病理诊断的纵隔疑难疾病 2 6例 ,高度怀疑或已明确诊断肺癌且影象学显示纵隔淋巴结肿大 (≥ 1.0 cm) 4 5例。 结果 2 6例纵隔疑难疾病患者 ,经纵隔镜检查后 2 5例获得明确诊断 ,确诊率为 96 .2 % (2 5 / 2 6 )。高度怀疑或病理诊断已确诊为肺癌的 4 5例 ,纵隔镜检查阳性 2 9例 ,阴性 16例。阳性者放弃手术 ,予以化疗 ;阴性者中 8例经开胸探查证实为肺癌 ,手术切除标本未发现纵隔淋巴结转移 ,特异性、敏感性均为 10 0 %。纵隔镜手术后发生声音嘶哑 1例 ,气胸 1例。无围手术期死亡。结论 纵隔镜手术创伤小、安全、取材可靠 ,是诊断纵隔疾病和明确肺癌术前分期最重要的方法。
Objective To explore the value of mediastinoscopy in the treatment of chest diseases and lung cancer staging. Methods Seventy - one patients underwent mediastinoscopy. Among them, 55 cases were treated by cervical mediastinoscopy, 12 cases by mediastinoscopy and 4 cases by neck and mediastinoscopy. There were 26 cases of mediastinal difficult diseases without clear pathological diagnosis before operation, highly suspected or confirmed lung cancer, and imaging showed mediastinal lymph nodes (≥ 1.0 cm) in 45 cases. Results Twenty-six patients with mediastinal diseases had a definite diagnosis after mediastinoscopy, with a diagnosis rate of 96.2% (25/26). Highly suspected or pathologically diagnosed as lung cancer in 45 cases, mediastinoscopy positive 29 cases, negative 16 cases. Positive patients gave up surgery, to be chemotherapy; negative in 8 cases of thoracic exploration confirmed lung cancer, surgical specimens were not found in mediastinal lymph node metastasis, specificity, sensitivity were 10%. One case of hoarseness after mediastinoscopy surgery, pneumothorax in 1 case. No perioperative deaths. Conclusion Mediastinoscopy operation trauma is small, safe, reliable, is the most important method of diagnosis of mediastinal diseases and clear preoperative staging of lung cancer.