Uchida Yosuke, Ando Satoko, Kida Atsunori, Morimoto Yuji
Department of Anesthesiology, Hokkaido University Hospital, Sapporo 060-8638.
Masui. 2011 Nov;60(11):1321-5.
A 77-year-old man underwent esophagectomy for esophageal cancer. Chest radiograph just after the operation showed opacification of the right lung. Although chest radiograph still showed a marked opacification of almost whole right lung in the ICU in spite of multiple bronchoscopy examination and suctioning of pulmonary secretions, he showed no dyspnea. On the second postoperative day, his respiratory symptoms deteriorated unexpectedly. Computed tomography showed torsion of the right upper and middle lobes, and urgent surgery was scheduled. Following double-lumen endotracheal intubation, thoracotomy was performed under one lung ventilation. The lung was found rotated. The surgeons tried to reduce the torsion to preserve the viable lung, but failed. Bleeding from infarcted lung was observed (approximately 150 ml). Accordingly, stapled lobectomy was performed. After the second surgery, he fortunately recovered without any complications. Although lung torsion is a rare complication, not only thoracic surgeons, but also we, anesthesiologists, should be aware of this disease.
一名77岁男性因食管癌接受了食管切除术。术后即刻胸部X线片显示右肺模糊。尽管在重症监护病房（ICU）进行了多次支气管镜检查并吸除了肺分泌物，但胸部X线片仍显示几乎整个右肺有明显模糊，不过他并无呼吸困难。术后第二天，他的呼吸症状意外恶化。计算机断层扫描显示右上叶和中叶扭转，遂安排了紧急手术。在双腔气管插管后，在单肺通气下进行了开胸手术。发现肺发生了扭转。外科医生试图复位扭转以保留有活力的肺，但未成功。观察到梗死肺出血（约150毫升）。因此，实施了吻合器肺叶切除术。第二次手术后，他幸运地康复且未出现任何并发症。尽管肺扭转是一种罕见的并发症，但不仅胸外科医生，我们麻醉医生也应该了解这种疾病。
