Deneffe G, Lacquet L M, Gyselen A
Eur J Respir Dis. 1983 Nov;64(8):613-9.
In the period 1975-1980, 1504 patients presented with lung cancer, 291 were presumably operable, and had no radiological evidence of mediastinal lymph node invasion. Two thirds (192 patients) underwent pre-operative surgical mediastinal exploration, and one third (99 patients) were operated right away. Of the 162 cervical mediastinoscopies, 16% had lymph node invasion (19.7% with right-sided, 10.6% with left-sided tumor); 28.9% of the 45 left-anterior mediastinotomies were positive. There was only one positive cervical mediastinoscopy of 46 cases with lower-lobe tumor, and no positive anterior mediastinotomy in 5 cases with left lower-lobe tumor. Mediastinal exploration yields, thus, a relatively higher percentage of positive results if the cervical mediastinoscopy is restricted to tumors affecting the right upper and middle lobes (25%), and if the anterior mediastinotomy is restricted to the left upper lobe (32.5%). A left anterior mediastinotomy should, thus, be recommended instead of cervical mediastinoscopy for tumors of the left upper lobe.
在1975年至1980年期间，1504例患者被诊断为肺癌，其中291例可能适合手术，且无纵隔淋巴结转移的影像学证据。三分之二（192例患者）接受了术前纵隔探查手术，三分之一（99例患者）直接进行了手术。在162例颈部纵隔镜检查中，16%存在淋巴结转移（右侧肿瘤为19.7%，左侧肿瘤为10.6%）；45例左前纵隔切开术中，28.9%为阳性。46例下叶肿瘤患者中，颈部纵隔镜检查仅1例阳性，5例左下叶肿瘤患者中，前纵隔切开术均无阳性结果。因此，如果颈部纵隔镜检查仅限于影响右上叶和中叶的肿瘤（25%），且前纵隔切开术仅限于左上叶（32.5%），纵隔探查的阳性结果比例相对较高。因此，对于左上叶肿瘤，应推荐采用左前纵隔切开术而非颈部纵隔镜检查。
