気管支性肺癌に対する縦隔鏡検査647例の臨床経験

MEDIASTINOSCOPY IN BRONCHOGENIC CARCINOMA: A REVIEW OF SIX HUNDRED FORTY SEVEN CASES

Ⅰ．緒論

　気管支性肺癌患者に対する手術法の選択は必ずしも容易なことではない。手術適応の如何を判断するためには日常の検査方法として胸部X線検査気管支鏡検査および心肺機能検査などいろいろの方法がある。諸統計によると上記術前検査法により診断された約50％の気管支性肺癌例は手術が不可能であり，あとの約40％が試験開胸後の所見より肺葉切除が不可能と報告されている。これら手術不可能例の大部分は開胸手術の際の所見で癌が縦隔洞内に波及し切除が不能と判断されたものである（Reynders 1964, Rodionov 1962）。

　1959年StockholmのCarlens氏が始めて縦隔のmidline approachにより両側上部縦隔の触診，視診および生検を行なうことができると記述した。

　Mediastinoscopy as devised by Carlens is a method of exploration employing palpation, inspection and biopsy of the superior mediastinum. The procedure, which has gained wide acceptance in the specialties of otolarygology and chest disease has proved very useful in establishing a diagnosis in thoracic diseases and, especially, in the assessment of resectability in bronchogenic carcinoma where conventional methods have failed. Positive biopsies were found in about one third of the number of cases seen. The most of these patients were excluded from surgery. A negative mediastinoscopy signifies an absence of mediastinal metastasis in a high percentage of cases.

　Few and slight complications were met with in the authors' total series of more than 1,200 patients subjected to mediastinoscopy. In addition to employing a gentle technic a thorough knowledge of the relevent normal and pathological anatomy is of the prime importance in avoiding complications and in obtaining satisfactory results.