纵隔镜手术在肺癌分期中的应用价值

目的:探讨纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值.方法:回顾性总结1999年11月至2003年7月69例经纵隔镜检查肺癌患者的临床资料,其中颈部纵隔镜手术57例,胸骨旁纵隔镜手术7例,颈部加胸骨旁纵隔镜手术5例.术前所有患者胸部CT均发现纵隔淋巴结肿大(最小直径大于1.0cm).结果:本组69例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者50例,未见纵隔淋巴结转移(阴性)者19例.阳性者放弃手术,予以化疗.阴性者中15例中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实14例纵隔淋巴结未见转移,1例隆突后淋巴结可见癌转移(纵隔镜检查假阴性).纵隔镜手术敏感性、特异性和准确性分别为98.0%、100%和98.5%.全组术后发生声音嘶哑1例,并发症发生率为1.4%(1/69).无围手术期死亡.结论:纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法.

The Value of Mediastinoscopy in the Staging of Lung Cancer

Objective: To determine the value of mediastinoscopy in the mediastinal staging of lung cancer. Methods: The study was retrospective, a total of 69 patients underwent mediastinoscopy for known or suspected lung cancer. These consisted of 57 cervical mediastinoscopies, 7 parasternal mediastinoscopies, 5 combined procedures. All the patients were detected enlarged mediastinal lymph nodes on radiographic examination of the chest (more than 1.0 cm on its shortest axis). Results: Of the 69 patients, 50 patients were found with N2 or N3 disease on mediastinoscopy. Among 19 mediastinoscopy-negative patients, 15 underwent thoracotomy for pulmonary resection and mediastinal lymph node dissection in the same operative session, thoracotomy-proven N0 was found in 14 patients, N2 in 1 patients (false-negative mediastinoscopy). The sensitivity, specificity, and accuracy of mediastinoscopy for the mediastinal staging of lung cancer were 98%, 100%, and 98.5%, respectively. In the entire group of 69 patients, there were 1 complications (1.4%), no perioperative death. Conclusion: Mediastinoscopy is a highly effective and safe procedure. It should be used routinely in the mediastinal staging of lung cancer.