Chiang C S, Chiang C D
Department of Medicine, Veterans General Hospital-Taichung, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1991 Nov;48(5):359-68.
Because of the independent and remote origin of the right upper and middle lobe bronchi, combined collapse of right upper and middle lobes is thought to be uncommon. We report 15 cases of combined right upper and middle lobe collapse found by plain chest radiograph in the past 8 years. Malignancies were confirmed in 13 cases. The other 2 cases with benign etiology included one case of endobronchial TB and one of pneumonia. These cases of combined bilobar collapse were possibly due to (1) the intraluminary infiltration of the primary tumor of the upper lobe to the middle lobe bronchus, (2) separated area of collapse produced by the primary tumor and its metastatic lymphadenopathy, (3) upper lobe tumor with external compression to intermediate bronchus that obstructed both the upper and middle bronchi, (4) multi-centric neoplasm, (5) tumor obstruction and sputum impaction at different bronchi, or (6) benign lesions operated at two different locations. The more frequent occurrence of bronchogenic carcinoma than that of benign lesions in our study revealed the invalidity of the "double lesion sign". Bronchoscopy or CT scan should be used to search for the etiology. If malignancy is confirmed in such condition, the prognosis is usually poor due to its advanced invasion.
由于右上叶和中叶支气管起源独立且位置较远，因此右上叶和中叶联合性肺不张被认为较为少见。我们报告了过去8年中通过胸部X线平片发现的15例右上叶和中叶联合性肺不张病例。其中13例确诊为恶性肿瘤。另外2例病因良性，包括1例支气管内膜结核和1例肺炎。这些双侧肺叶联合性肺不张病例可能是由于：（1）上叶原发性肿瘤腔内浸润至中叶支气管；（2）原发性肿瘤及其转移性淋巴结病导致的分离性肺不张区域；（3）上叶肿瘤向外压迫中间支气管，阻塞了上叶和中叶支气管；（4）多中心肿瘤；（5）不同支气管处的肿瘤阻塞和痰液嵌塞；或（6）在两个不同部位进行手术的良性病变。在我们的研究中，支气管肺癌的发生率高于良性病变，这表明“双病变征”无效。应使用支气管镜检查或CT扫描来寻找病因。如果在此种情况下确诊为恶性肿瘤，由于其侵袭程度较晚，预后通常较差。
