电视纵隔镜手术应用于胸外科40例
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摘要
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.
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.
引文
1 Carlens E.Mediastinoscopy:a method for inspection and tissue biopsy in the superior mediastinum.Dis Chest,1959,36(4):343-352.
2 Annema JT,van Meerbeeck JP,Rintoul RC,et al.Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer:a randomized trial.JAMA,2010,304(20):2245-2252.
3 傅尧箕.纵隔镜检查术.中华外科杂志,1965,13:760-761.
4 王俊,赵辉.纵隔镜术及其在肺癌分期中的应用价值.中华胸心血管外科杂志,2002,18(2):190-192.
5 Pearson FG,Delarue NC,Ilves R,et al.Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung.J Thorac Cardiov Sur,1982,83(1):1-11.
6 Rosell R,Gomez-Codina J,Camps C,et al.Preresectional chemotherapy in stageⅢA non-small-cell lung cancer:a 7-year assessment of a randomized controlled trial.Lung cancer,1999,26(1):7-14.
7 De Leyn P,Dooms C,Kuzdzal J,et al.Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer.Eur J Cardiothorac Surg,2014,45(5):787-798.
8 Bohm J,Boisdur L,Elze M,et al.Improved lymph node staging of lung cancer using EBUS-TBNA and liquid-based cytology:an alternative to mediastinoscopy?Onkologie,2011,34:149.
9 Ahmed-Nusrath A,Annamanneni R,Wyatt R,et al.Management of major hemorrhage during mediastinoscopy.J Cardiothor Vasc Anesth,2006,20(5):762-763.
10 Park BJ,Flores R,Downey RJ,et al.Management of major hemorrhage during mediastinoscopy.J Thorac Cardiov Sur,2003,126(3):726-731.
11 Alpay L,Lacin T,Kosar A,et al.Diagnostic algorithm in patients with superior vena cava syndrome and efficacy of cervical mediastinoscopy.Acta Chir Belg,2014,114(5):309-312.
12 Arslan E,Sanli M,Ulusan A,et al.Cervical mediastinoscopy:an alternative method for mediastinal cyst excision.Turk Gogus Kalp Dama,2013,21(3):813-816.
13 Pop D,Venissac N,Leo F,et al.Video-assisted mediastinoscopy:a useful technique for paratracheal mesothelial cysts.J Thorac Cardiovasc Surg,2005,129(3):690-691.
14 Zwishchenberger JB,Savage C,Alpard SK,et al.Mediastinal transthoracic needle and core lymph node biopsy:should it replace mediastinoscopy?Chest,2002,121(4):1165-1170.
15 Koide N,Takeuchi D,Suzuki A,et al.Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities.Surg Today,2012,42(2):127-134.
16 Nomura T,Matsutani T,Hagiwara N,et al.Mediastinoscopy-assisted transhiatal esophagectomy for esophageal cancer:a singleinstitutional cohort study.Surg Laparo Endo Per,2016,26(6):E153-E156.
17 徐正浪,谭黎杰,王群,等.影像监视经纵隔镜食管癌切除术10例报道.上海医学大学学报,1999,26(3):227-228.
18 Li GS.Prof.Qingdong Cao:single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer.J Thoracic Dis,2016,8(9):E1108-E1109.
19 Bulgen SB,Salihoglu Z,Demirkaya A,et al.A retrospective analysis of high-risk patients for mediastinoscopy.Turk Gogus Kalp Dama,2013,21(3):699-705.
2 Annema JT,van Meerbeeck JP,Rintoul RC,et al.Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer:a randomized trial.JAMA,2010,304(20):2245-2252.
3 傅尧箕.纵隔镜检查术.中华外科杂志,1965,13:760-761.
4 王俊,赵辉.纵隔镜术及其在肺癌分期中的应用价值.中华胸心血管外科杂志,2002,18(2):190-192.
5 Pearson FG,Delarue NC,Ilves R,et al.Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung.J Thorac Cardiov Sur,1982,83(1):1-11.
6 Rosell R,Gomez-Codina J,Camps C,et al.Preresectional chemotherapy in stageⅢA non-small-cell lung cancer:a 7-year assessment of a randomized controlled trial.Lung cancer,1999,26(1):7-14.
7 De Leyn P,Dooms C,Kuzdzal J,et al.Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer.Eur J Cardiothorac Surg,2014,45(5):787-798.
8 Bohm J,Boisdur L,Elze M,et al.Improved lymph node staging of lung cancer using EBUS-TBNA and liquid-based cytology:an alternative to mediastinoscopy?Onkologie,2011,34:149.
9 Ahmed-Nusrath A,Annamanneni R,Wyatt R,et al.Management of major hemorrhage during mediastinoscopy.J Cardiothor Vasc Anesth,2006,20(5):762-763.
10 Park BJ,Flores R,Downey RJ,et al.Management of major hemorrhage during mediastinoscopy.J Thorac Cardiov Sur,2003,126(3):726-731.
11 Alpay L,Lacin T,Kosar A,et al.Diagnostic algorithm in patients with superior vena cava syndrome and efficacy of cervical mediastinoscopy.Acta Chir Belg,2014,114(5):309-312.
12 Arslan E,Sanli M,Ulusan A,et al.Cervical mediastinoscopy:an alternative method for mediastinal cyst excision.Turk Gogus Kalp Dama,2013,21(3):813-816.
13 Pop D,Venissac N,Leo F,et al.Video-assisted mediastinoscopy:a useful technique for paratracheal mesothelial cysts.J Thorac Cardiovasc Surg,2005,129(3):690-691.
14 Zwishchenberger JB,Savage C,Alpard SK,et al.Mediastinal transthoracic needle and core lymph node biopsy:should it replace mediastinoscopy?Chest,2002,121(4):1165-1170.
15 Koide N,Takeuchi D,Suzuki A,et al.Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities.Surg Today,2012,42(2):127-134.
16 Nomura T,Matsutani T,Hagiwara N,et al.Mediastinoscopy-assisted transhiatal esophagectomy for esophageal cancer:a singleinstitutional cohort study.Surg Laparo Endo Per,2016,26(6):E153-E156.
17 徐正浪,谭黎杰,王群,等.影像监视经纵隔镜食管癌切除术10例报道.上海医学大学学报,1999,26(3):227-228.
18 Li GS.Prof.Qingdong Cao:single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer.J Thoracic Dis,2016,8(9):E1108-E1109.
19 Bulgen SB,Salihoglu Z,Demirkaya A,et al.A retrospective analysis of high-risk patients for mediastinoscopy.Turk Gogus Kalp Dama,2013,21(3):699-705.