目的 探讨单孔胸腔镜下前纵隔支气管囊肿切除的治疗效果。 方法 回顾性分析 2009 年 3 月至 2015 年 4 月我院 26 例前纵隔支气管囊肿患者的临床资料，其中男 17 例、女 9 例，平均年龄 32.4（25～51）岁。均行单孔胸腔镜手术治疗，分析其临床症状、影像学特点及手术疗效。 结果 本组 26 例患者平均手术时间 62.0（48～110）min，平均出血量 98.4（60～120）ml，术后平均住院时间 8.7（6～12）d。术后 25 例患者无手术并发症，1 例术后因不配合主动咳嗽，出现肺不张及胸腔积液，给予调整胸腔引流管，加强咳嗽后恢复良好。术后平均随访 9.6（1～18）个月，复查 CT 均无复发。 结论 前纵隔支气管囊肿难以根据影像学诊断，最终需术后病理检查确诊。单孔胸腔镜手术可作为治疗前纵隔支气管囊肿首选方法。
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.