Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China.
J Thorac Cardiovasc Surg. 2016 Sep;152(3):737-745.e3. doi: 10.1016/j.jtcvs.2016.03.077. Epub 2016 Apr 13.
Lung torsion (LT) is a rare but life-threatening event. The objective of this study was to systematically review the natural history and clinical outcome of LT in published studies.
A review of publications on LT from January 1950 to December 2014 was performed using 3 databases (PubMed, EMBASE, and Web of Science). The primary efficacy outcome was LT-related mortality. Intervention was classified as direct resection (resection without detorsion), indirect resection (resection after detorsion), and reposition. Univariate comparisons of survival were performed using a logistic regression model.
There were 109 patients from 91 studies identified in this analysis. LT was frequently reported after upper lobectomy (74.4%) and the middle lobe was the most vulnerable lesion (29.4%). The main clinical presentations were dyspnea (38.4%), fever (23.3%), and chest pain (17.4%). Radiologic findings suggestive of LT included worsening consolidation and abrupt truncation/tapering of the pulmonary artery. The overall mortality was 8.3%. Univariate analysis showed that the extent of torsion (whole LT vs lobar torsion) was significantly associated with survival (odds ratio, 5.867; P = .017). No significant difference was found between patients receiving direct resection and those receiving reposition; a trend was observed for worsening outcomes in patients treated with indirect resection (odds ratio, 5.300; P = .060).
The systematic review reveals the prevalence, key diagnostic tests, and optimal treatment methods for lung torsion. Whole LT is associated with higher mortality rates than lobar torsion. If the tortuous part is viable, reposition and direct resection have similar survival rates; otherwise, direct resection should be performed.
肺扭转（LT）是一种罕见但危及生命的事件。本研究的目的是系统地回顾已发表的研究中 LT 的自然病史和临床结果。
使用 3 个数据库（PubMed、EMBASE 和 Web of Science）对 1950 年 1 月至 2014 年 12 月发表的 LT 文献进行综述。主要疗效结果是 LT 相关死亡率。干预措施分为直接切除（不扭转切除）、间接切除（扭转后切除）和复位。使用逻辑回归模型对生存进行单变量比较。
本分析共纳入 91 项研究的 109 例患者。LT 常发生在上肺叶切除术后（74.4%），中叶是最易受损的病变（29.4%）。主要临床表现为呼吸困难（38.4%）、发热（23.3%）和胸痛（17.4%）。提示 LT 的放射学表现包括肺部实变恶化和肺动脉突然截断/变细。总的死亡率为 8.3%。单变量分析显示，扭转程度（全 LT 与肺段扭转）与生存率显著相关（优势比，5.867；P=0.017）。直接切除与复位患者之间无显著差异；间接切除患者的预后恶化趋势（优势比，5.300；P=0.060）。
系统综述揭示了肺扭转的流行程度、关键诊断试验和最佳治疗方法。全 LT 比肺段扭转死亡率更高。如果扭曲部分存活，复位和直接切除的生存率相似；否则，应进行直接切除。
