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目的：探讨利用纵隔镜检查术诊断胸部疑难疾病。方法：１９９２年１０月至１９９６年１２月对３７例胸部疑难病例施行纵隔镜检查术。手术在气管内全身麻醉下进行，经气管前间隙人工隧道观察气管周围肿物和淋巴结并进行活检。结果：病理确诊率为８３７８％（３１／３７），其中良性病变比率达６１２９％（１９／３１）。位于气管前、气管旁、气管支气管拐角区、隆突下的病变纵隔镜检查的确诊率大于８３％，位于气管后、前纵隔及距气管较远的纵隔其他部位为纵隔检查的盲区。病变直径在３厘米以下的病理确诊率９２８６％，直径３厘米以上的确诊率５５５５％。并发症为１例颈部切口感染，发生率２７％。结论：纵隔镜检查阳性率与病变部位有关（Ｐ＝００２５），而与病变大小无关（Ｐ＝１０００）。胸部疑难病例最常见的误诊病种是结核病和结节病，故试验性放、化疗的习惯作法需慎重
Objective: To explore the use of mediastinoscopy to diagnose difficult chest diseases. Methods: From October 1992 to December 1996, operative mediastinoscopy was performed on 37 cases of chest problems. The operation was performed under general anesthesia in the trachea. The tracheal tumors and lymph nodes were observed through an artificial trachea before the trachea and biopsy was performed. Results: The pathological diagnosis rate was 83.78% (31/37), and the benign lesion rate was 61. 29% (19/31). Located in front of the trachea, paratracheal, tracheobronchial corner, and carotid lumbosacral lesions, the diagnosis rate of mediastinoscopy is greater than 83%. It is located in the posterior trachea, anterior mediastinum, and other parts of the mediastinum farther from the trachea. The pathological diagnosis rate of lesions below 3 cm was 92.86%, and the diagnostic accuracy was 55.5%. The complication was one case of cervical incision infection with an incidence of 2.7%. Conclusions: The positive rate of mediastinoscopy is related to the location of the lesion (P=0.025), but not to the size of the lesion (P=1.000). The most commonly misdiagnosed cases of difficult-to-thick chest cases are tuberculosis and sarcoidosis, so the customary practice of experimental radiotherapy and chemotherapy needs to be considered carefully.