应用纵隔镜检查术诊断纵隔淋巴结结核和结节病

目的寻找和探索一种区分良恶性纵隔淋巴结肿大，确诊纵隔淋巴结结核和结节病的有效方法。方法应用纵隔镜检查术对胸部ＣＴ或ＭＲＩ检查发现的纵隔淋巴结肿大、临床诊断不清疑为淋巴结结核或结节病者实施此检查，获取病理组织，做出明确诊断，以指导治疗。结果本组２５例患者接受纵隔镜检查，其中１６例被病理诊断为纵隔淋巴结结核，占６４％（其中增殖性结核１４例，占８８％；干酪性结核２例，占１２％）；８例诊为结节病，占３２％；１例难于确定为淋巴结结核或结节病，占４％。非典型的纵隔淋巴结结核与结节病在影像诊断上难于区别，而且在显微镜下也极易混淆。这两种疾病常与其他原因引起的纵隔淋巴结肿大（如恶性淋巴瘤、淋巴结转移性癌等）在影像检查中不易区分，极易误诊，造成误治。本组病例术前影像诊断及临床诊断大多考虑为恶性疾病，其中第一诊断为恶性疾病的占８４％（２１／２５），有２例已在外院接受化疗。结论对于纵隔区域发现的肿大淋巴结，纵隔镜检查术是一种很有价值的确诊手段，治疗前应尽一切可能获取明确的病理诊断

The role of mediastinoscopy for the diagnosis of mediastinal tuberculous lymphadenopathy and sarcoidosis

Objective To find a effective method for diagnosing tuberculous lymphadenopathy and sarcoidosis of mediastinum. Methods Mediastinoscopy was conducted in patients who had enlarged mediastinal lymph nodes on chest CT or MRI and were clinically suspected of either tuberculosis or sarcoidosis. Biopsy was done to obtain pathological diagnosis, and make therapeutic program. Results Of this series of 25 patients, 16 cases were pathologically diagnosed as tuberculous lymphadenopathy, representing 64% ( hyperplastic tuberculosis 14 cases; caseous tuberculosis 2 cases); 8 cases were sarcoidosis, representing 32% ; one case was difficult to tell tuberculosis from sarcoidosis microscopically, representing 4%. Tuberculosis and sarcoidosis were causes of benign enlargement of mediastinal lymph nodes. They were hard to be differentiated from roentgnologically, sometimes even microscopically; and they might be confused with other malignant diseases, which can also cause the enlargement of mediastinal lymph nodes, such as lymphoma, metastatic malignancies, etc. Thus they were easily resulted in misdiagnosis. Of this series, the initial diagnosis of 21 cases were malignancies, representing 84%, two cases has even undergone chemotherapy at local hospitals. Conclusions For patients with enlargement of mediastinal lymph nodes, mediastinoscopy is of great value. It was emphasized to make every effort to obtain definite pathological diagnosis before standard treatment.