Yagi K, Oomasa M, Tanaka T, Miyamoto Y
Division of Respiratory Surgery, Himeji National Hospital, Japan.
Kyobu Geka. 1996 Dec;49(13):1055-9; discussion 1059-62.
The usefulness of mediastinoscopy for lung cancer was retrospectively evaluated for the aspect of prognosis. The subjects were 421 patients with primary lung cancer except exploratory thoracotomy. In the MD(+) group, there was no difference in prognosis between right and left sided thoracotomies, but in the MD(-) group there was a tendency for poorer prognosis in the left-sided thoracotomy (p < 0.1). In the right-sided thoracotomy, there was no difference of prognosis between the MD(+) group and MD(-) group. On the contrary, in the left-sided thoracotomy there was a statistically better prognosis in the MD(+) group than in the MD(-) group (p < 0.05). In the left-sided thoracotomy group, there was a statistically better prognosis in the MD +) group than in the MD(-) group in the pN 0 or pN 1 group (p < 0.01), but there was no difference of prognosis in the pN 2 group. In lung cancer of the left side, the mediastinal lymph node dissection would be more incomplete because of the presence of the aorta and the mediastinal lymph node metastasis would tend to be missed. Mediastinoscopy gives the right diagnosis of mediastinal lymph node metastasis and an accurate staging of lung cancer. Mediastinoscopy is very useful especially in the left-sided lung cancer.
回顾性评估了纵隔镜检查对肺癌预后的作用。研究对象为421例除开胸探查术外的原发性肺癌患者。在纵隔镜检查阳性(MD(+))组中,左右侧开胸手术的预后无差异,但在纵隔镜检查阴性(MD(-))组中,左侧开胸手术有预后较差的趋势(p<0.1)。在右侧开胸手术中,MD(+)组和MD(-)组的预后无差异。相反,在左侧开胸手术中,MD(+)组的预后在统计学上优于MD(-)组(p<0.05)。在左侧开胸手术组中,pN0或pN1组的MD(+)组预后在统计学上优于MD(-)组(p<0.01),但pN2组的预后无差异。在左侧肺癌中,由于主动脉的存在,纵隔淋巴结清扫可能更不彻底,纵隔淋巴结转移可能容易被漏诊。纵隔镜检查能正确诊断纵隔淋巴结转移并准确进行肺癌分期。纵隔镜检查非常有用,尤其在左侧肺癌中。