Bowen T E, Zajtchuk R, Green D C, Brott W H
J Thorac Cardiovasc Surg. 1978 Aug;76(2):269-71.
Neoplasms of the left upper lobe may spread directly to the anterior mediastinal group of nodes without involving the inferior tracheobronchial, superior tracheobronchial, or paratracheal nodal chain. Routine cervical mediastinoscopy does not sample the anterior mediastinal node group. Parasternal anterior mediastinotomy was performed in 28 patients with left upper lobe carcinoma and normal findings from cervical mediastinoscopy. Despite the normal findings at cervical mediastinoscopy, 10 of the 28 patients were deemed to have inoperable disease because of spread of the neoplasm to the anterior nodal group or because of direct neoplastic involvement of the aorta or main pulmonary artery. All patients in whom results of anterior mediastinotomy were normal had resectable lesions at thoracotomy. Fourteen of the 16 patients who came to thoracotomy had normal hilar nodes. Parasternal anterior mediastinotomy, introduced by Chamberlain, should be performed in addition to standard cervical mediastinoscopy if the nodal drainage of left upper lobe neoplasms is to be more completely evaluated. Combining these two procedures samples all major drainage pathways except the posterior mediastinal nodal chain.
左上叶肿瘤可能直接扩散至前纵隔淋巴结组，而不累及下气管支气管、上气管支气管或气管旁淋巴结链。常规颈部纵隔镜检查不会取前纵隔淋巴结组的样本。对28例左上叶癌且颈部纵隔镜检查结果正常的患者进行了胸骨旁前纵隔切开术。尽管颈部纵隔镜检查结果正常，但28例患者中有10例因肿瘤扩散至前淋巴结组或因肿瘤直接侵犯主动脉或主肺动脉而被认为患有无法手术的疾病。所有前纵隔切开术结果正常的患者在开胸手术时均有可切除的病变。接受开胸手术的16例患者中有14例肺门淋巴结正常。如果要更全面地评估左上叶肿瘤的淋巴结引流，除了标准的颈部纵隔镜检查外，还应进行由张伯伦引入的胸骨旁前纵隔切开术。将这两种方法结合起来可以对除后纵隔淋巴结链之外的所有主要引流途径进行取样。
