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目的:总结纵隔淋巴结检测的各种临床方法及其临床价值。方法:应用PubMed、维普检测系统,以“非小细胞肺癌”、“纵隔淋巴结”和“检测方法”等为检索词,检索1997-2013年的相关文献。纳入标准:1)非小细胞肺癌(NSCLC)相关进展;2)纵隔淋巴结转移的生存现状;3)纵隔淋巴结各种临床检测手段。根据纳入标准分析文献31篇。结果:CT和PET-CT诊断纵隔淋巴结的准确性不高,无法获得明确病理诊断,但它能提供准确的胸部解剖。纵隔镜仍是诊断纵隔淋巴结转移的金标准,其准确率>90%,但存在较高的手术并发症,限制了其发展。随腔内内镜超声的发展,食管镜超声引导针吸活检和气管镜超声引导针吸活检的准确率也能到达90%,但都有其检查的盲点,对于这些地方则无能为力。结论:联合检测可以提高纵隔淋巴结检出率和准确性,特别是在影像学的定位下,食管镜超声引导针吸活检和气管镜超声引导针吸活检联合使用可能成为检测纵隔淋巴结的新选择。
Objective: To summarize various clinical methods and clinical value of mediastinal lymph node detection. Methods: PubMed and Wipu detection system were used to search the relevant literature from 1997 to 2013 with the terms of “non-small cell lung cancer”, “mediastinal lymph node” and “detection method”. Inclusion criteria: 1) the progress of non-small cell lung cancer (NSCLC); 2) the survival status of mediastinal lymph node metastasis; 3) various clinical detection of mediastinal lymph nodes. Based on the inclusion criteria, 31 articles were analyzed. Results: The accuracy of CT and PET-CT in diagnosing mediastinal lymph nodes was not high enough to obtain definite pathological diagnosis, but it could provide accurate chest anatomy. Mediastinoscopy is still the gold standard for the diagnosis of mediastinal lymph node metastases, with an accuracy rate of> 90%, but there are high surgical complications that limit its development. With the development of endoscopic ultrasonography, the accuracy of esophagoscopic guided needle aspiration biopsy and endoscopic ultrasonography guided needle aspiration biopsy can reach 90%, but there are blind spots for their examination, which can not be done in these areas. Conclusion: Combined detection can improve the detection rate and accuracy of mediastinal lymph nodes. Especially under the imaging location, the combination of esophagoscopic guided needle aspiration and endoscopic ultrasonography guided needle aspiration biopsy may be a new choice for detecting mediastinal lymph nodes.