Wassermann K, Reitemeyer E, Müller K M, Nakhosteen J A
Abteilung für Lungen- und Bronchialheilkunde, Augusta-Kranken-Anstalten, Bochum, BRD.
Respiration. 1988;53(2):91-110. doi: 10.1159/000195402.
On the basis of comprehensive clinicopathological evidence 6 patients presenting with unilateral left-sided hyperlucent lungs are evaluated for pathogenesis, function and postoperative (n = 5) course. The common denominator in all proves to be moderate to severe hypoperfusion and overinflation of the respective lungs. Pulmonary function is characterized by a combined restrictive-obstructive pattern. In 4 patients overinflation is due to a central check-valve mechanism (tumor: n = 3; central airways collapse: n = 1), whereas in 2 increased translucency results from some sort of peripheral obstruction (Swyer-James syndrome: n = 1; congenital cystic bronchiectasis: n = 1). We consider the origin of hypoperfusion to be alveolar distension and hypoxic precapillary vasoconstriction, both participating in diminished blood flow to the check-valve obstructed lung. In Swyer-James syndrome reduced vascularity is an additional feature. Preoperative and long-term postoperative lung function data of 5 pneumonectomized patients are compared. On the whole, FEV1 and IVC remain unchanged, whereas the obstructive profile (RV, RV/TLC, sRAW) improves. From these data it is concluded that the affected hyperlucent lung is 'amputated' even before operation - irrespective of the nature of tissue damage. On the other hand postoperative relief of airways obstruction is supposed to be due to both antiobstructive medication and the removal of a diseased lung.
基于全面的临床病理证据，对6例表现为左侧单侧肺透亮度增加的患者的发病机制、功能及术后（n = 5）病程进行了评估。所有病例的共同特征是相应肺叶存在中度至重度灌注不足和过度充气。肺功能表现为限制性和阻塞性混合模式。4例患者的过度充气是由于中央单向活瓣机制（肿瘤：n = 3；中央气道塌陷：n = 1），而另外2例透亮度增加是由某种外周阻塞引起（斯怀尔-詹姆斯综合征：n = 1；先天性囊状支气管扩张：n = 1）。我们认为灌注不足的根源是肺泡扩张和缺氧性毛细血管前血管收缩，两者均导致流向单向活瓣阻塞肺叶的血流减少。在斯怀尔-詹姆斯综合征中，血管减少是另一个特征。比较了5例肺切除患者的术前和长期术后肺功能数据。总体而言，第一秒用力呼气容积（FEV1）和肺活量（IVC）保持不变，而阻塞性指标（残气量、残气量/肺总量、比气道阻力）有所改善。从这些数据可以得出结论，即使在手术前，受影响的透亮肺就已经“被切除”了——无论组织损伤的性质如何。另一方面，术后气道阻塞的缓解被认为是由于抗阻塞药物治疗和病肺切除两者共同作用的结果。
