Yamane Masaomi, Sano Y, Nagahiro I, Aoe M, Date H, Shimizu N
Department of Cancer and Thoracic Surgery, School of Medicine, Okayama University, Okayama, Japan.
Kyobu Geka. 2005 Dec;58(13):1153-7.
We reviewed our experience on postoperative lobar torsion. From January 1994 to December 2003, 1002 patients underwent lobectomy for lung cancer. Two (0.2%) patients with postoperative lobar torsion required surgical reintervention. The first case was that of a 79-year-old man who underwent left lower lobectomy for pulmonary adenocarcinoma. Based on the postoperative course, lobar torsion was highly suspected with progressive respiratory dysfunction and the chest X-ray showed complete opacification of the residual lobe. Rethoracotomy was performed on postoperative day 4. The left upper lobe was rotated clockwise, and completion pneumonectomy was carried out. The patient died 16 days after the second surgery because of respiratory failure due to severe pneumonia. The second case was that of a 24-year-old man with a diagnosis of metastatic lung cancer in the right upper lobe arising from pharyngeal cancer. The patient underwent right upper lobectomy and developed hemoptysis and persistent high fever. A chest computed tomography (CT) and bronchoscopy findings revealed lobar torsion of the middle lobe, and a reoperation was performed. The middle lobe was resected and the patient was discharged 8 days after the rethoracotomy. Pulmonary lobar torsion poses a difficult diagnostic dilemma in the early postoperative period after the pulmonary resection. Since late reoperation for postoperative lobar torsion sometimes results in poor prognosis, careful observation with bronchial fiberscopy as well as chest radiography is necessary for accurate diagnosis. Rethoracotomy should be carried out without any delay in cases of lobar torsion following pulmonary resection.
我们回顾了我们在术后肺叶扭转方面的经验。1994年1月至2003年12月，1002例患者接受了肺癌肺叶切除术。两名（0.2%）术后发生肺叶扭转的患者需要再次手术干预。第一例是一名79岁男性，因肺腺癌接受了左下肺叶切除术。根据术后病程，高度怀疑肺叶扭转伴有进行性呼吸功能障碍，胸部X线显示残余肺叶完全不透明。术后第4天进行了再次开胸手术。左上叶顺时针旋转，并进行了全肺切除术。患者在第二次手术后16天因严重肺炎导致呼吸衰竭死亡。第二例是一名24岁男性，诊断为源于下咽癌的右上叶转移性肺癌。该患者接受了右上肺叶切除术，术后出现咯血和持续高热。胸部计算机断层扫描（CT）和支气管镜检查结果显示中叶肺叶扭转，遂进行了再次手术。切除了中叶，患者在再次开胸手术后8天出院。肺叶扭转在肺切除术后的早期阶段构成了诊断难题。由于术后肺叶扭转的晚期再次手术有时会导致预后不良，因此需要通过支气管纤维镜检查以及胸部X线摄影进行仔细观察以准确诊断。对于肺切除术后发生肺叶扭转的病例，应毫不延迟地进行再次开胸手术。
