中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

电视纵隔镜手术应用于胸外科 40 例

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目的 评估电视纵隔镜手术的安全性、有效性及临床应用价值。 方法 回顾性分析 2011 年 12 月至 2016 年 12 月我院单中心使用电视纵隔镜连续完成 40 例患者的临床资料,其中男 25 例、女 15 例,平均年龄 54.6 岁,包括纵隔淋巴结活检 27 例,纵隔原发病灶活检 8 例,纵隔镜下支气管囊肿切除 3 例,纵隔镜经颈部游离胸上段食管 2 例。 结果 纵隔淋巴结活检确诊率 73.1%,其中肉芽肿性病变 14 例,淋巴结转移 6 例(非小细胞肺癌 4 例,尤文肉瘤 1 例,小细胞肺癌 1 例), 淋巴结反应性增生 7 例(26.9%)。纵隔原发病灶活检的确诊率 100.0%,病理结果均为恶性肿瘤,其中小细胞肺癌 5 例,腺样囊性癌 1 例,鳞癌 1 例,腺癌 1 例。支气管囊肿 3 例术后随访 2 年无复发。全组严重并发症 1 例(无名动脉损伤),一般并发症 4 例,其中 2 例喉返神经暂时麻痹,2 例伤口渗液。 结论 电视纵隔镜是一个评估纵隔病变的有效工具,在纵隔淋巴结肉芽肿性炎的患者活检中需要警惕大血管损伤。

Objective To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease. Methods We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2. Results The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion. Conclusion Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.

关键词: 纵隔镜; 纵隔肉芽肿性炎; 支气管囊肿

Key words: Mediastinoscopy; granulomatous mediastinitis; bronchial cystectomy

引用本文: 王哲, 吴齐飞, 张广健, 贾卓齐, 李新举, 陈建, 付军科. 电视纵隔镜手术应用于胸外科 40 例. 中国胸心血管外科临床杂志, 2017, 24(12): 957-961. doi: 10.7507/1007-4848.201704038 复制

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