【摘要】 目的探讨CT和纵隔镜在肺癌术前分期中的优势及其局限性。方法163例术前高度怀疑或已确诊为肺癌的患者,行胸CT和经颈纵隔镜检查术和/或扩大经颈纵隔镜检查术,对适合手术的108例患者行开胸手术和淋巴结清扫,然后比较CT和纵隔镜术对判断纵隔淋巴结转移的敏感度、特异度、准确率、阳性和阴性预测值;CT判断纵隔淋巴结阳性的标准为淋巴结短径≥1.0cm,长径≥1.5cm。结果CT检查对判断纵隔淋巴结转移的敏感度为74.4%,特异度为75.4%,准确率75.0%,阳性预测值63.0%,阴性预测值为83.9%。纵隔镜检查对判断纵隔淋巴结转移的敏感度为94.9%,特异度为100%,准确率96.3%,阳性预测值100%,阴性预测值97.2%。纵隔镜检查对判断纵隔淋巴结转移的敏感度、特异度、准确率、阳性预测值和阴性预测值等均明显优于CT检查(P<0.05、P<0.01)。结论纵隔镜对判断肺癌纵隔淋巴结转移明显优于CT,而且安全,具有无创性,易被患者接受,是术前的必要检查方法。更多还原

【Abstract】 Objective To explore the value and limitations of CT and mediastinoscopy in preoperative mediastinal lymph node staging in lung cancer.Methods 163 patients with suspected or diagnosed lung cancer underwent both CT and mediastinoscopy,of whom 108 eligible for surgery received thoracotomy and mediastinal lymphadenectomy.The comparison of sensitivity,specificy,accuracy,positive and negative predictive value to mediastinal lymph node metastasis between CT and mediastinoscopy was made.The standard for mediastinal staging of CT was mediastinal lymph node ≥1.0 cm in short diameter or ≥1.5 cm in long diameter.Results The sensitivity,specificy,accuracy,positive predictive value and negative predictive value of CT to mediastinal lymph node metastasis were ~74.4% ,75.4%,75.0%,63.0% and 83.9%,which of mediastinoscopy were 94.9%,100%,96.3%,100% and ~97.2% .Mediastinoscopy was superior to CT in sensitivity,specificy,accuracy,positive predictive value and negative predictive value(P<0.05,P<0.01).Conclusion Mediastinoscopy is superior to CT in judgment of mediastinal lymph node metastasis,safe and tolerant,which is the necessary preoperative investigation.更多还原