Upile T, Triaridis S, Kirkland P, Goldstraw P, Rhys Evans P
Head and Neck Unit, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
Clin Otolaryngol. 2005 Dec;30(6):561-5. doi: 10.1111/j.1749-4486.2005.01056.x.
Tumours that arise in the thoracic inlet and superior mediastinum may be benign or malignant and present the surgeon with a difficult problem of access. The standard approach to the thoracic inlet from below offers limited exposure to the vascular and neural structures superior to the tumours. The anterior thoraco-cervical approach to the root of the neck and superior mediastinum combines the anterior cervical approach with a limited upper median sternotomy. If further access is required to achieve surgical clearance a full sternotomy split can be performed. The approach offers excellent exposure and helps to facilitate complete resection of benign and malignant tumours, which would otherwise be deemed inoperable or difficult to resect completely through other standard approaches. In contrast to previously described anterior transcervical thoracic approaches which required resection of part of the clavicle or manubrium as well as thoracotomy with increased morbidity, the anterior thoraco-cervical approach is associated with little morbidity and the postoperative stay is short.
发生于胸廓入口和上纵隔的肿瘤可能是良性或恶性的，给外科医生带来了手术入路的难题。从下方进入胸廓入口的标准方法，对于肿瘤上方的血管和神经结构暴露有限。颈胸前路入路至颈部根部和上纵隔，是将颈前入路与有限的上正中胸骨切开术相结合。如果需要进一步扩大手术视野以实现手术切除，则可进行全胸骨劈开。该入路提供了极佳的暴露，有助于促进良性和恶性肿瘤的完整切除，否则这些肿瘤通过其他标准方法将被认为无法手术或难以完全切除。与先前描述的经颈胸前路入路相比，后者需要切除部分锁骨或胸骨柄以及开胸手术，从而增加了发病率，而颈胸前路入路的发病率很低，术后住院时间短。
