电视纵隔镜在肺癌术前分期中的应用

目的:探讨电视纵隔镜检查术在肺癌术前分期中的应用。方法:40例患者接受了经颈纵隔镜检查术或（和）前纵隔切开术，36例确诊为肺癌但因纵隔淋巴结肿大（直径>1cm）需作术前分期，4 例高度怀疑为肺部恶性肿瘤。结果:电视纵隔镜检查未见纵隔淋巴结转移者28例，中转开胸行肺叶切除加纵隔淋巴结清扫，术后病理均证实为肺癌，手术切除标本未发现纵隔淋巴结转移，与电视纵隔镜检查结果相符。淋巴结转移阳性者12例，均放弃开胸手术，N2 期淋巴结转移10例，接受新辅助化疗；N3 期淋巴结转移2 例，接受放化疗。电视纵隔镜手术平均手术时间62min，平均出血量50mL，切口无感染，出血1 例，并发症发生率为2.5%（1/40），无围手术期死亡。本组电视纵隔镜检查对肺癌术前纵隔淋巴结分期的准确性、敏感性和特异性均达到100% 。结论:电视纵隔镜手术创伤小，是肺癌术前病理分期的重要检查方法，具有确诊率高、安全可靠等优点。 

The Value of Video-Mediastinoscopy in Preoperative Staging of Lung Cancer

Objective:To study the value of Video-Mediastinoscopy (VM) in preoperative staging of lung cancer.Methods: Forty patients underwent VM through cervical or (and) anterior mediastinum parasternal approach. Among the 40, 36 had mediastinal lymphnodes smaller than 1 cm and were pathologically diagnosed with lung cancer. The other 4 patients were highly suspected with lung cancer clinically. Results: VM showed that28patients had no involvement in the mediasti-nal lymph nodes and all of them underwent thoracotomy and lobectomy, with dissection of the mediastinal lymph nodes. The postoperative pathologic diagnosis showed that there were no cancer cell infiltration, consistent with the results of VM. Twelve cases were found with positive lymphnodes and surgical treatment was not considered. Among these12patients, 10were of N2 and received neoadjuvant chemotherapy, 2 were of N3 and received chemotherapy or radiation therapy. The average duration of VM surgery was 62minutes and the mean blood loss was50mL. No infection of incision was seen. The rate of complication was 2.5% (1/40) and no death occurred. The sensitivity and specificity of VM in staging mediasti-nal lymph nodes of lung cancer preoperatively were 100 %.Conclusion:Video Mediastinoscopy is a useful surgical proce-dure for the diagnosis and staging of lung cancer, with high diagnostic rate and less trauma.