Baltayiannis N, Bolanos N
Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece.
J BUON. 2002 Jan-Mar;7(1):25-30.
The syndrome after pneumonectomy is an unusual complication of pneumonectomy resulting from excessive displacement of the mediastinal structures toward the empty pleural space. In infants, children, and infrequently in young or middle- aged adults, excessive mediastinal shift after pneumonectomy occurs gradually. The resultant compression of the remaining contralateral bronchus leads to severe respiratory compromise. Development of the syndrome is most common after right pneumonectomy, is infrequently seen after left pneumonectomy in patients with a right-sided aortic arch, and is observed rarely after left pneumonectomy in patients with a normal position of the aortic arch in the left hemithorax. The typical clinical presentation is that of dyspnea, which occurs months or years after surgery, and the diagnosis is confirmed by documenting, on computed tomographic scan or by bronchoscopy, significant tracheobronchial obstruction. The problem can be corrected by restoration of the normal relation of the mediastinal structures, which is best achieved by inserting a tissue expander in the empty chest cavity. Endoluminal stenting seems to offer the most efficient treatment of associated tracheobronchomalacia.
肺切除术后综合征是肺切除术后一种不常见的并发症，由纵隔结构过度向空的胸腔移位所致。在婴儿、儿童中，以及在年轻或中年成人中较少见的情况下，肺切除术后纵隔过度移位是逐渐发生的。由此导致的对侧剩余支气管受压会引起严重的呼吸功能损害。该综合征在右肺切除术后最为常见，在右位主动脉弓患者的左肺切除术后很少见，而在主动脉弓位于左半胸正常位置的患者左肺切除术后则罕见。典型的临床表现为呼吸困难，发生在术后数月或数年，通过计算机断层扫描或支气管镜检查证实存在明显的气管支气管阻塞来确诊。通过恢复纵隔结构的正常关系可纠正该问题，这最好通过在空胸腔内插入组织扩张器来实现。腔内支架置入似乎为相关气管支气管软化提供了最有效的治疗方法。
