Cable D G, Deschamps C, Allen M S, Miller D L, Nichols F C, Trastek V F, Pairolero P C
Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
J Thorac Cardiovasc Surg. 2001 Dec;122(6):1091-3. doi: 10.1067/mtc.2001.117839.
We reviewed our experience on postoperative lobar torsion.
Between January 1972 and January 1998, 7887 patients underwent pulmonary resection at our institution. Seven (0.089%; 4 women and 3 men; median age, 68 years) patients required surgical reintervention for lobar torsion.
The indications for pulmonary resection were non-small cell carcinoma in 5 patients, lymphoma in 1 patient, and metastatic prostate carcinoma in 1 patient. The right upper lobe was resected in 3 patients, the left lower lobe in 2 patients, and the right middle and right lower lobe in 1 patient each. Postoperative radiographs demonstrated pulmonary infiltrates and volume loss in 5 patients and complete opacification in 2 patients. The median white blood cell count was 10.6 x 10(9) cells/L (range, 9.3-14.9 x 10(9) cells/L), and the median peak temperature was 38.4 degrees C (range, 37.8 degrees C-40.2 degrees C) during the first 48 hours postoperatively. The diagnosis of lobar torsion was made a median of 10 days (range, 2-14 days) after the initial operation; 4 patients underwent completion pneumonectomy, and 3 had lobectomy. Median hospitalization was 24 days and ranged from 10 to 56 days. There were no postoperative deaths. Complications after reoperation included respiratory failure in 2 patients, atrial arrhythmia in 2 patients, and empyema, urinary tract infection, and a transient ischemic attack in 1 patient each.
Lobar torsion represents a difficult diagnostic dilemma in the early postoperative period after pulmonary resection. A high index of suspicion is necessary to avoid a delay in treatment. Late diagnosis results in further pulmonary resection and prolonged hospitalization in the majority of cases.
我们回顾了我们在术后肺叶扭转方面的经验。
在1972年1月至1998年1月期间，我们机构有7887例患者接受了肺切除术。7例（0.089%；4例女性和3例男性；中位年龄68岁）患者因肺叶扭转需要再次手术干预。
肺切除的指征为5例非小细胞肺癌、1例淋巴瘤和1例转移性前列腺癌。3例患者切除了右上叶，2例患者切除了左下叶，1例患者分别切除了右中叶和右下叶。术后X线片显示5例患者有肺部浸润和肺容积减少，2例患者完全肺不张。术后头48小时内，白细胞计数中位数为10.6×10⁹/L（范围为9.3 - 14.9×10⁹/L），体温峰值中位数为38.4℃（范围为37.8℃ - 40.2℃）。肺叶扭转的诊断在初次手术后中位10天（范围为2 - 14天）做出；4例患者接受了全肺切除术，3例患者接受了肺叶切除术。中位住院时间为24天，范围为10至56天。无术后死亡病例。再次手术后的并发症包括2例呼吸衰竭、2例房性心律失常，以及各1例脓胸、尿路感染和短暂性脑缺血发作。
肺叶扭转在肺切除术后早期是一个难以诊断的难题。必须保持高度的怀疑指数以避免治疗延误。在大多数情况下，晚期诊断会导致进一步的肺切除和住院时间延长。
