Lemaire Anthony, Nikolic Ivana, Petersen Thomas, Haney Jack C, Toloza Eric M, Harpole David H, D'Amico Thomas A, Burfeind William R
Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Thorac Surg. 2006 Oct;82(4):1185-9; discussion 1189-90. doi: 10.1016/j.athoracsur.2006.05.023.
Mediastinoscopy is a valuable tool for evaluating mediastinal pathology and is essential for establishing treatment strategies in most patients with lung cancer. We sought to determine the complication and false negative rate for mediastinoscopy in an institution that routinely performs this procedure.
We performed a retrospective review of 2,145 consecutive mediastinoscopies at a single institution between April 1996 and April 2005. Demographics and complications were analyzed. In patients with lung cancer who underwent subsequent resection, the false negative rate was calculated.
Mean patient age was 61 +/- 0.4 years, and 58% (n = 1,253) were male. Pathology included lung cancer (n = 1,459), metastatic disease (n = 78), lymphoma (n = 51), and other benign disease (n = 557). Twenty-three patients (1.07%) experienced complications including hemorrhage (n = 7, 0.33%), vocal cord dysfunction (n = 12, 0.55%), tracheal injury (n = 2, 0.09%), and pneumothorax (n = 2, 0.09%). There was 1 death (0.05%) after pulmonary artery injury. Five of the 7 vascular injuries occurred during biopsy of level 4R. Three hundred and forty-three patients (23.5%) with lung cancer had positive mediastinoscopies. The false negative rate was 56 of 1,019 (5.5%) among lung cancer patients undergoing resection. Thirty-two (57%) of the false negatives were due to metastatic disease in lymph nodes not normally biopsied during cervical mediastinoscopy (levels 5, 6, 8, or 9).
Although invasive, mediastinoscopy identified locally advanced disease in a significant percentage of this lung cancer population and was associated with a low false negative rate. Complications after mediastinoscopy were uncommon. These results support the continued routine use of mediastinoscopy.
纵隔镜检查是评估纵隔病变的重要工具，对大多数肺癌患者制定治疗策略至关重要。我们试图确定在一个常规开展该手术的机构中纵隔镜检查的并发症及假阴性率。
我们对1996年4月至2005年4月间在一家机构连续进行的2145例纵隔镜检查进行了回顾性分析。分析了患者的人口统计学特征及并发症情况。对接受后续切除术的肺癌患者计算假阴性率。
患者平均年龄为61±0.4岁，58%（n = 1253）为男性。病理类型包括肺癌（n = 1459）、转移性疾病（n = 78）、淋巴瘤（n = 51）及其他良性疾病（n = 557）。23例患者（1.07%）出现并发症，包括出血（n = 7，0.33%）、声带功能障碍（n = 12，0.55%）、气管损伤（n = 2，0.09%）和气胸（n = 2，0.09%）。肺动脉损伤后有1例死亡（0.05%）。7例血管损伤中有5例发生在4R区活检时。343例（23.5%）肺癌患者纵隔镜检查结果为阳性。在接受切除术的肺癌患者中，假阴性率为1019例中的56例（5.5%）。32例（57%）假阴性是由于颈部纵隔镜检查（5、6、8或9区）通常未活检的淋巴结发生转移性疾病所致。
尽管纵隔镜检查具有侵入性，但在相当比例的肺癌患者中能发现局部晚期疾病，且假阴性率较低。纵隔镜检查后的并发症并不常见。这些结果支持继续常规使用纵隔镜检查。
