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目的 探讨纵隔镜对纵隔肿瘤的诊断价值以及在肺癌分期中的应用。方法 41例患者接受了经颈纵隔镜检查术或 (和 )前纵隔切开术 ,其中纵隔肿瘤或不明原因淋巴结肿大 12例 ,临床怀疑为肺部恶性肿瘤 3例 ,肺癌治疗前纵隔淋巴结分期不明 2 6例。结果 12例纵隔肿瘤或纵隔不明原因的肿大淋巴结经颈纵隔镜或 (和 )前纵隔切开术后 ,经病理明确诊断为恶性胸腺瘤 1例、转移性肺癌 1例、转移性腺癌 1例、纵隔淋巴结淋巴滤泡增生 1例、成熟性畸胎瘤 1例、结节病 1例和肺炎性假瘤 1例 ,结核 3例 ,余 2例未能确诊 ;诊断符合率为 83.3%。 41例中有 3例临床怀疑为肺部肿瘤 ,经颈纵隔镜检查 1例诊断为结核 ;2例未能确诊 ,后经胸腔镜和剖胸探查诊断 ,1例为肺非霍奇金淋巴瘤 ,1例为肺炎性假瘤。2 6例肺癌纵隔镜诊断纵隔淋巴结转移的灵敏度为 87.5 % ,特异度为 10 0 %。全组术后切口感染 1例 ,无其他合并症。结论 纵隔镜对诊断纵隔肿瘤和对肺癌的分期安全准确。
Objective To explore the diagnostic value of mediastinoscopy in mediastinal tumor and its application in lung cancer staging. Methods Thirty-one patients underwent mediastinoscopy or anterior mediastinal dissection. Among them, 12 cases had mediastinal tumor or unexplained lymph node enlargement, 3 cases were suspicious of pulmonary malignancy, 3 cases had mediastinal lymph node staging before treatment of lung cancer, Unknown 26 cases. Results Of the 12 cases with mediastinal tumor or enlarged mediastinal lymphadenectomy by cervical mediastinoscopy and / or anterior mediastinum, one case of malignant thymoma, one case of metastatic lung cancer and one case of metastatic adenocarcinoma were diagnosed by pathology , 1 case of mediastinal lymph node follicular hyperplasia, 1 case of mature teratoma, 1 case of sarcoidosis and 1 case of inflammatory pseudotumor and 3 cases of tuberculosis. The other 2 cases failed to be diagnosed. The diagnostic coincidence rate was 83.3%. Three of the 41 cases were clinically suspected as lung tumors, one was diagnosed as tuberculosis by mediastinoscopy, two were diagnosed as non-Hodgkin’s lymphoma, one was diagnosed by thoracoscopy and thoracotomy, and one was non-Hodgkin’s lymphoma of the lung , 1 case of inflammatory pseudotumor. 26 cases of lung cancer mediastinoscopy diagnosis of mediastinal lymph node metastasis was 87.5% sensitivity and specificity of 100%. All the patients had incision infection in 1 case, no other complications. Conclusion Mediastinoscopy is safe and accurate for the diagnosis of mediastinal tumors and staging of lung cancer.