Levasseur P, Regnard J F, Levi J F
Service de Chirurgie Thoracique et Vasculaire de l'Hôpital Marie Lannelongue, Le Plesis-Robinson.
Chirurgie. 1992;118(3):156-64; discussion 164-5.
In order to achieve mediastinal lymph node staging in bronchial cancer, axial mediastinoscopy (combined with left anterior mediastinoscopy for cancers of the left upper lobe) is by far the most efficient and the most reliable technique. Since mediastinoscopy has been part of the investigations that can be made before thoracotomy, the number of exploratory thoracotomies has considerably decreased in all teams, thus reducing intraoperative mortality at the same time. Thoracic CT, which arrived in the diagnostic weaponry against lung cancer a long time after mediastinoscopy, has a major asset in that it allows selecting the patients for whom mediastinoscopy seems to be useful, on the basis of criteria related to the size of mediastinal lymph nodes (10 mm generally being the threshold chosen to perform mediastinoscopy or not). For almost all authors, systematic mediastinoscopy is no longer useful at present. Similarly, positive mediastinoscopic findings must not lead to systematically refuse patients, as the invasion or absence of invasion of a mediastinal lymph node is neither necessary nor sufficient to discuss a surgical indication. While some still automatically refuse all patients with positive mediastinoscopy, most authors still remain very interventionistic for N2 patients selected on the basis of very accurate criteria that are analyzed above, and surgery can then be performed at once or, for some authors, after a "neo-adjunctive" therapy, the long-term efficacy of which has unfortunately not been rigorously demonstrated as yet.
为了实现支气管癌的纵隔淋巴结分期，轴向纵隔镜检查（对于左上叶癌联合左前纵隔镜检查）是目前最有效且最可靠的技术。由于纵隔镜检查已成为开胸手术前可进行的检查项目之一，所有团队的 exploratory thoracotomies 数量都大幅减少，同时降低了术中死亡率。胸部CT在纵隔镜检查很久之后才成为肺癌诊断手段，其主要优势在于能根据纵隔淋巴结大小相关标准（一般以10毫米作为是否进行纵隔镜检查的阈值）筛选出似乎适合进行纵隔镜检查的患者。对于几乎所有作者而言，目前系统性纵隔镜检查已不再有用。同样，纵隔镜检查结果为阳性不一定就必须拒绝患者，因为纵隔淋巴结有无受侵对于讨论手术指征既非必要条件也非充分条件。虽然仍有一些人会自动拒绝所有纵隔镜检查结果为阳性的患者，但大多数作者对于根据上述非常精确的标准筛选出的N2患者仍非常积极干预，然后可以立即进行手术，或者对于一些作者来说，在进行“新辅助”治疗后手术，遗憾的是，其长期疗效尚未得到严格证实。
