Department of Thoracic Surgery, National Hospital Organization YamaguchiUbe Medical Center, Ube, Japan.
Thorac Cancer. 2020 Jun;11(6):1712-1715. doi: 10.1111/1759-7714.13421. Epub 2020 Apr 4.
Air leakage is a common complication after pulmonary resection, which is usually caused by direct lung damage during surgery. Herein, we describe a case in which a pulmonary cyst developed rapidly in the right lower lobe and ruptured 10 days after right upper lobectomy. A 49-year-old man, who was a heavy smoker, underwent thoracoscopic right upper lobectomy for primary lung cancer. No air leakage was observed postoperatively, and the chest drain tube was removed on postoperative day 1. Although his postoperative course was uneventful for more than a week, extensive subcutaneous emphysema developed unexpectedly on postoperative day 10. Computed tomography (CT) scan revealed a large pulmonary cyst in the right lower lobe that was not present before the right upper lobectomy. Surgery was performed on postoperative day 13, and it revealed a large thick-walled pulmonary cyst in the right lower lobe. The cyst was filled with blood clots, and air leaks were observed inside it, suggesting that the dissection of the pulmonary parenchyma caused its development. The cyst wall was sutured together with the pulmonary parenchyma, and no air leakage was subsequently observed. KEY POINTS: Significant findings of the study In patients with fragile pulmonary tissue, the pulmonary parenchyma may become dissociated after pulmonary resection and induce rapid development of a pulmonary cyst. Risk factors for pulmonary cyst development include upper lobectomy and emphysema. Pulmonary cysts are often formed in the lower lobe. What this study adds In patients with pulmonary emphysema post-upper lobectomy, the fragility of the pulmonary parenchyma and hyperinflation of the remaining lung may cause dissection of the pulmonary parenchyma, resulting in massive air leakage.
漏气是肺切除术后的常见并发症，通常是由于手术过程中直接损伤肺部引起的。在此，我们描述了一例右下肺肺大疱在右上肺叶切除术后 10 天迅速破裂的病例。一名 49 岁男性，重度吸烟，因原发性肺癌行胸腔镜右上肺叶切除术。术后无漏气，术后第 1 天拔除胸腔引流管。尽管术后一周以上无并发症，但术后第 10 天突然出现广泛皮下气肿。胸部 CT 扫描显示右下肺有一个大的肺大疱，在上肺叶切除术前不存在。术后第 13 天行手术，发现右下肺有一个大的厚壁肺大疱。大疱内充满了血凝块，内部可见漏气，提示肺实质的分离导致其发展。大疱壁与肺实质缝合在一起，随后没有漏气。关键点：研究的重要发现在肺组织脆弱的患者中，肺叶切除术后肺实质可能分离，并导致肺大疱迅速发展。肺大疱发展的危险因素包括上叶切除术和肺气肿。肺大疱常形成于下叶。本研究增加的内容在上肺叶切除术后肺气肿患者中，肺实质的脆弱性和剩余肺的过度充气可能导致肺实质的分离，导致大量漏气。
