Yoshizawa Masatoshi, Murasawa Masaki, Ishida Hisao, Kuwabara Masayoshi
Department of Respiratory Surgery, The Second Okamoto General Hospital, Uji, Japan.
Kyobu Geka. 2016 Apr;69(4):325-7.
The patient was a 60-year-old woman who underwent chest wall resection for a metastatic tumor in the anterior portion of the right 3rd rib, from thyroid cancer. The anterior portion of the right 3rd rib and the 2nd and 3rd intercostal muscles were resected, and chest wall reconstruction was not performed. On the 5th postoperative day, the patient developed a pulmonary hernia. Radiologically, more than half of the right upper lobe and middle lobe were prolapsed from the resected chest wall. The patient complained of cough and dyspnea, and an emergency surgery was performed. Elevated intrathoracic pressure due to obesity was considered to be a serious risk factor of the lung hernia after chest wall resection without reconstruction.
该患者为一名60岁女性,因甲状腺癌转移至右第3肋前部的肿瘤接受了胸壁切除术。切除了右第3肋前部以及第2和第3肋间肌,未进行胸壁重建。术后第5天,患者出现了肺疝。影像学检查显示,右肺上叶和中叶的一半以上从切除的胸壁处脱垂。患者主诉咳嗽和呼吸困难,遂进行了急诊手术。肥胖导致的胸内压升高被认为是胸壁切除未重建后发生肺疝的一个严重危险因素。