摘要
由於影像學技術的進步，使得放射線診斷成為檢查肺癌最常用的工具，但若要取得確定的組織切片，則需要侵入性的方式。縱膈腔鏡為目前最常採用的手術切片方法，具有傷口小，易於取得組織，病人恢復快等優點。 自1992至2001年間共有四十五位病人接受縱膈腔鏡手術，大多數病人術前皆無診斷，我們回溯四十五位病人接受縱膈腔鏡並比較電腦斷層之結果。手術時間平均五十分鐘，術後住院平均日數為二日。 二十五位病人為縱膈腔腫瘤或良性淋巴結增生，二十一位為肺腫瘤併縱膈腔淋巴結腫大，其中十位病人是小細胞肺癌，六位病人是腺癌，三位是鱗狀細胞癌，二位是良性細胞增生。這二位病人其中一位接受左下肺全肺切除及縱膈腔淋巴結擴清術，但病理診斷有縱膈腔淋巴擴散。另一位病人接受開胸手術，肺腫瘤及縱膈腔淋巴結均為小細胞癌。此二病人為縱膈腔鏡偽陰性結果。所有病人皆無術後死亡情形，三個病人產生併發症，二位是輕微淋巴液洩漏但無傷口感染，另一位病人發生氣胸及皮下氣腫，需插入胸管治療。 縱膈腔鏡是診斷肺癌及分期的一種良好的工具。現今大多於電腦斷層發現有縱膈腔淋巴結腫大情形之後，用縱膈腔鏡進行切片確定。若有淋巴結擴散，則肺葉切除手術可能無法達成，如此可減低不必要的開胸手術以減低手術併發症及死亡率。但縱膈腔鏡有其偽陰性的可能，此時可以胸腔鏡為切片方法以降低此一發生率。
並列摘要
Background: Over the years, radiological studies, especially CT scans of the chest, have been the mainstream methods used in the diagnosis of lung cancer with mediastinal metastases. However, there are limitations to the accuracy of diagnosis. Mediastinoscopy has been recently advocated as an alternative method for diagnosis and to confirm inoperability. We reviewed 45 patients who had received mediastinoscopy and compared the results with those of CTs. Methods: The cervical mediastinoscopy technique was performed with 45 patients. All of them had lesions in the lungs and mediastinum. Mean operative time was 50 minutes (range, 40 to 70 minutes) and mean hospital stay was 2 days. Results: Twenty-five patients had mediastinal tumors, and 21 patients had lung tumors with enlarged mediastinal lymph nodes. Ten of the 21 patients had small cell lung cancer, six had adenocarcinoma, and 3 had squamous cell carcinoma. The other 2 patients had a mediastinoscopic diagnosis of benign lymphoid hyperplasia. One underwent a radical lobectomy, and N2 lymph node metastasis was obtained. The other received a thoracotomy with tumor excision, and the final histologic diagnosis was small cell lung carcinoma. The two patients had false negative results by mediastinoscopy. There was no surgical mortality or intra-operative complication. One patient had pneumothorax and subcutaneous emphysema, and required a chest tube insertion. Conclusions: A survey using a chest CT scan first and mediastinoscopy later for the diagnosis of mediastinal lymph node metastasis is safe and informative in the staging procedure. A VATS or anterior thoracotomy should be considered as another choice when mediastinoscopy has the possibility of an inadequate or inaccurate result.