Hsu Han-Shui, Wang Liang-Shun, Hsieh Chih-Cheng, Wang Chien-Ying, Wu Yu-Chung, Huang Biing-Shiun, Hsu Wen-Hu, Huang Min-Hsiung
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC.
J Chin Med Assoc. 2003 Apr;66(4):231-5.
Mediastinoscopy is a widely used technique in the diagnosis of mediastinal disease and the staging of bronchogenic carcinoma. Its efficacy in the preoperative staging of lung cancer is well-established, with a procedural sensitivity of greater than 90% and specificity of 100%. Mediastinoscopy can also establish the diagnosis in greater than 90% of mediastinal disease. We conducted a retrospective study of mediastinoscopy performed at our institution between 1998 and 2001 to evaluate the safety and efficacy of mediastinoscopy.
We collected 100 consecutive mediastinoscopies performed in Thoracic Division of Taipei Veterans General Hospital between 1998 and 2001. The indications for mediastinoscopy included mediastinal mass or lymphadenopathy and the staging of lung cancer. Some patients had the undetermined lung mass with enlarged mediastinal lymph node.
There were 69 men and 31 women aged from 13 to 87 (mean 60.9). Sixty-seven patients had mediastinoscopy for the staging of lung cancer, 29 patients for diagnosis of mediastinal mass or lymphadenopathy, and 4 patients for undetermined lung mass with mediastinal lymphadenopathy. Among the patients with mediastinal disease, sarcoidosis was diagnosed in 13 patients, and lymphoma in 5 patients. N2 or N3 nodal metastasis was revealed in 38 of 67 patients who had lung cancer. Fifteen patients with negative mediastinoscopy proceeded to thoracotomy for tumor resection. Seventeen patients received neoadjuvant chemotherapy followed by resection. There were three complications, all due to bleeding, and no mortality.
Mediastinoscopy is a safe and effective procedure for the diagnosis of mediastinal disease and the staging of lung cancer. In cases of lung cancer, mediastinoscopy can provide more accurate evaluation of mediastinal lymph node metastasis than conventional diagnostic tools like computed scan or magnetic resonance image with low morbidity and mortality.
纵隔镜检查是诊断纵隔疾病和支气管肺癌分期的一种广泛应用的技术。其在肺癌术前分期中的有效性已得到充分证实，操作敏感性大于90%，特异性为100%。纵隔镜检查还能在超过90%的纵隔疾病中确诊。我们对1998年至2001年在我院进行的纵隔镜检查进行了一项回顾性研究，以评估纵隔镜检查的安全性和有效性。
我们收集了1998年至2001年在台北荣民总医院胸外科连续进行的100例纵隔镜检查病例。纵隔镜检查的适应证包括纵隔肿块或淋巴结肿大以及肺癌分期。一些患者有肺部肿块未明且纵隔淋巴结肿大。
共有69例男性和31例女性，年龄从13岁至87岁（平均60.9岁）。67例患者因肺癌分期进行纵隔镜检查，29例患者因诊断纵隔肿块或淋巴结肿大进行纵隔镜检查，4例患者因肺部肿块未明且纵隔淋巴结肿大进行纵隔镜检查。在纵隔疾病患者中，13例诊断为结节病，5例诊断为淋巴瘤。67例肺癌患者中有38例显示N2或N3淋巴结转移。15例纵隔镜检查阴性的患者进行了开胸肿瘤切除术。17例患者接受了新辅助化疗后进行切除。有3例并发症，均因出血，无死亡病例。
纵隔镜检查是诊断纵隔疾病和肺癌分期的一种安全有效的方法。在肺癌病例中，纵隔镜检查比计算机断层扫描或磁共振成像等传统诊断工具能更准确地评估纵隔淋巴结转移，且发病率和死亡率较低。
