Hajjar Waseem, Elmedany Yasser, Bamousa Ahamed, Saladein Moataz, Ashour Mahmoud, Fouda Mohammed, Al-Kattan Khaled
Thoracic Surgery Division, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Med Princ Pract. 2002 Oct-Dec;11(4):210-3. doi: 10.1159/000065808.
To report our experiences of surgical diagnostic procedures in patients with unidentified mediastinal pathology.
From July 1995 to July 1999, 72 patients with mediastinal pathology had 73 surgical procedures for the purpose of tissue diagnosis. Of the 72 patients, 39 were female and 33 male, with an average age of 54 years. Mediastinoscopy and anterior mediastinotomy were performed in 54 and 15 patients, respectively (13 left and 2 right). Thoracoscopy was used in 3 cases, and 2 patients were diagnosed via cervical incision. Superior vena cava (SVC) obstruction was noted in 4 patients and four procedures were repeat procedures. Frozen section analysis was performed in 52 cases.
Tissue diagnosis was achieved in all cases, enabling a specific diagnosis in 70 cases (97%). In 2 patients, the final diagnosis was non-specific and in 1 patient repeat biopsy was needed. The diagnoses were lymphoma (n = 32), tuberculosis (n = 20), metastatic disease (n = 11) and other pathology (n = 9). There was no operation-related mortality although 1 patient developed mediastinal haematoma, which was treated conservatively. The 2 in-hospital deaths resulted from causes secondary to the primary disease (invasive aspergilloma or Hodgkin's lymphoma).
Mediastinoscopy is a safe surgical procedure with high diagnostic yield. Its routine use with mediastinotomy and thoracoscopy ensures accurate diagnosis. Careful surgical technique is mandatory in repeat procedures and SVC obstruction cases.
报告我们对不明纵隔病变患者进行手术诊断操作的经验。
1995年7月至1999年7月，72例纵隔病变患者接受了73次以组织诊断为目的的手术操作。72例患者中，女性39例，男性33例，平均年龄54岁。分别对54例和15例患者进行了纵隔镜检查和前纵隔切开术（13例为左侧，2例为右侧）。3例患者采用了胸腔镜检查，2例患者通过颈部切口确诊。4例患者出现上腔静脉（SVC）梗阻，4次手术为重复手术。52例进行了冰冻切片分析。
所有病例均实现了组织诊断，70例（97%）得以明确诊断。2例患者最终诊断不明确，1例患者需要再次活检。诊断结果为淋巴瘤（n = 32）、结核病（n = 20）、转移性疾病（n = 11）和其他病变（n = 9）。尽管有1例患者出现纵隔血肿并接受了保守治疗，但无手术相关死亡病例。2例住院死亡是由原发性疾病（侵袭性曲霉菌病或霍奇金淋巴瘤）的继发原因导致的。
纵隔镜检查是一种安全且诊断率高的手术操作。其与纵隔切开术和胸腔镜检查的常规联合使用可确保准确诊断。在重复手术和SVC梗阻病例中，必须采用精细的手术技术。
