Carbognani P, Rusca M, Spaggiari L, Cattelani L, Bobbio A, Romani A, Solli P
Department of General Thoracic and Vascular Surgery, University of Parma, Italy.
J Cardiovasc Surg (Torino). 1996 Dec;37(6 Suppl 1):177-8.
The preoperative diagnosis of the involvement of the N2 lymph nodes is very important in patients with NSCLC for the most appropriate treatment. The classical diagnostic techniques for mediastinal exploration, mediastinoscopy and left anterior mediastinotomy, have been recently integrated by videothoracoscopy. FromJanuary 1993 to April 1994 186 patients with NSCLC suitable for surgery, were observed in our Department. 18 patients (9%) had CT evidence of N2 disease. In 10 cases the sites of the nodal enlargement were the right paratracheal station (#2 according to Naruke) and the right tracheobronchial station (#4), in 4 the subcarinal station (#7), in 2 the subaortic (#5) and in the remaining 2 cases the paraaortic station (#6). 14 mediastinoscopies were performed to investigate the stations 2,4 and 7,2 videothoracoscopies for station 5 and 2 left anterior mediastinotomies for station 6. The histological diagnosis was obtained in all cases without intraoperative or postoperative complications. Because the sequence chemotherapy-surgery seems to obtain the best results in the treatment of N2 disease the preoperative diagnosis of nodal involvement is of outstanding importance. Until recently mediastinoscopy and anterior left mediastinotomy were considered the standard techniques to explore mediastinum, now also videothoracoscopy has been introduced. In our experience, the integration of all the above techniques allowed a complete study of each suspect N2 site. Particularly the videothoracoscopy is very useful to safely biopsy under direct vision the aortic window lymph nodes.
对于非小细胞肺癌（NSCLC）患者，术前诊断N2淋巴结受累情况对于选择最合适的治疗方法非常重要。传统的纵隔探查诊断技术，如纵隔镜检查和左前纵隔切开术，最近已被电视胸腔镜检查所补充。1993年1月至1994年4月，我科观察了186例适合手术的NSCLC患者。18例（9%）有CT证据显示N2期病变。其中，10例肿大淋巴结位于右气管旁区域（根据Naruke分类为#2组）和右气管支气管区域（#4组），4例位于隆突下区域（#7组），2例位于主动脉下区域（#5组），其余2例位于主动脉旁区域（#6组）。对2、4和7组进行了14次纵隔镜检查，对5组进行了2次电视胸腔镜检查，对6组进行了2次左前纵隔切开术。所有病例均获得了组织学诊断，且无术中或术后并发症。由于在N2期病变的治疗中，先化疗后手术的顺序似乎能取得最佳效果，因此术前诊断淋巴结受累情况至关重要。直到最近，纵隔镜检查和左前纵隔切开术一直被视为探查纵隔的标准技术，现在电视胸腔镜检查也已被引入。根据我们的经验，综合运用上述所有技术能够对每个可疑的N2区域进行全面检查。特别是电视胸腔镜检查对于在直视下安全地对主动脉窗淋巴结进行活检非常有用。
