摘要
目的探讨胸部手术后肺（叶）扭转的原因。方法回顾性分析8例胸部手术后并发肺（叶）扭转病例，其中男5例，女3例，平均年龄（55±8）岁，肺叶切除术4例（左上叶和右上叶各2例），食管癌切除术2例，右上纵隔巨大神经鞘瘤切除术和降主动脉置换术各1例。结果术后发生扭转的肺叶中，右中叶2例，右上叶1例，左上叶3例，左下叶1例，左全肺1例。术后48h内平均体温38．4℃（37．8—40．2℃），血白细胞数10．6×10^9／L（9．3—14．9×10^9／L）。术后胸部X线片提示肺浸润和容积减少6例，完全实变2例。确诊肺扭转距初次手术的平均时间为4d（2-14d），再次手术时行扭转肺（叶）切除6例，均痊愈；行病肺复位2例，均死亡。再次手术后并发呼吸衰竭2例，房颤2例，平均住院日为24d（10—56d）。结论胸部手术后（残）肺门游离和肺不张是发生扭转的主要原因。早期确诊肺扭转较难，高度怀疑时应立即手术；宜采取病肺切除术。
Objective To analyze retrospectively 8 cases of postoperative lobar torsion after thoracotomy. Methods 8 cases of postoperative lobar torsion were collected （5 men and 3 women ; median age, 55.0 ±7.7 years）, including lobectomy 4 （left upper lobe of lung 2, right upper lobe of lung 2） , esophageal carcinosectomy 2, resection of schwannoma in the right upper mediastinum 1, and descending aorta replacement 1. Results The postoperative lobar torsions were right middle lobe 2, right upper lobe 1, left upper lobe 3, left lower lobe 1, left lung 1. The median peak temperature was 38.4℃ （ range, 37.8- 40.2℃ ） and the median white blood cell count was 10. 6 × 10^9cells/L （range, 9.3-14.9 × 10^9cell/L） during the first 48 hours postoperatively. Postoperative radiographs demonstrated pulmonary infiltrates and volume loss in 6 patients and complete opacification in 2 patients. The diagnosis of lobar torsion was made a median of 4 days（range, 2-14 days） after the initial operation; 6 patients underwent resection of lung and recovered; 2 had the injured lobe or lung rotated and died. Complications after reoperation included respiratory failture in 2 patients, atrial arrhythmia in 2 patients. Median hospitalization was 24 days and range from 10 to 56 days. Conclusions The mobilization of hilus of lung or residual pulmonary atelectasis is the main mechanism of the lobar torsion after thoracotomy. Lobar torsion represents a difficult diagnostic dilemma in the early postoperative period after thoracotomy. Exploratory thoracotomy must be performed without delay. The injured parenchyma should be sacrificed unless the diagnosis is obtained very early. When the injured lobe or lung is rotated back into normal position, simultaneous endotracheal suction is very important to prevent aspiration of fluid from the obstructed part of the bronchial tree to the uninvolved segments and dangerous postoperative hypoxia.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第27期1915-1917,共3页
National Medical Journal of China
关键词
肺
扭转
外科手术
Lung
Torsion
Surgical operative
