Ali Razhan K, Kakamad Fahmi H, Hama Ali Abdalla Shalaw, Hussein Shakhawan I, Salih Abdulwahid M, Salih Rawezh Q, Mohammed Shvan H, Hussien Dahat A, Hassan Marwan N, Abdulla Berwn A, Abdullah Hiwa O, Othman Snur, Mikael Tomas M Sharif M
Shar Hospital, College of Medicine, Sulaimani, Iraq.
University of Sulaimani, Sulaimani, Iraq.
Ann Med Surg (Lond). 2021 Jul 31;69:102610. doi: 10.1016/j.amsu.2021.102610. eCollection 2021 Sep.
Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy.
A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. He was a chronic heavy smoker (100 pack/year). Work up revealed squamous cell carcinoma. Although he had poor pulmonary function tests, he underwent left upper lobectomy. On the fifth postoperative day, he was discharged from the hospital as there was no air leak and the lung remained expanded 15 hours after clamping of the thoracostomy tube. Two days later, the patient developed generalized subcutaneous emphysema. The patient was re-admitted to the hospital and a thoracostomy tube was inserted. The lung expanded upon insertion while the subcutaneous emphysema remained the same and even slightly increased over night. A 3 cm incision was made at the left infra-clavicular area and a negative pressure applied to it. The subcutaneous emphysema completely subsided a few hours after this intervention.
Because of the benign course, the majority of cases of subcutaneous emphysema (mild to moderate) only need nonoperative management alongside treatment of the predisposing factors. These patients may need nothing other than bed rest, good analgesia, supplemental oxygen, and reassurance.
Subcutaneous emphysema after lobectomy prolongs hospital stay. It mainly occurs in cases with poor pulmonary function tests, steroid use, and those with extensive adhesion.
皮下气肿是肺叶切除术后极为罕见的并发症。本研究旨在报告一例肺癌患者肺叶切除术后发生广泛皮下气肿的病例。
一名73岁男性，出现呼吸困难和咳嗽1个月，伴有喘息和咳痰。他是一名长期重度吸烟者（100包/年）。检查发现为鳞状细胞癌。尽管他的肺功能测试结果较差，但仍接受了左上肺叶切除术。术后第5天，由于没有漏气且在夹闭胸腔闭式引流管15小时后肺仍保持膨胀，他出院了。两天后，患者出现全身性皮下气肿。患者再次入院并插入了胸腔闭式引流管。插入引流管后肺膨胀，而皮下气肿保持不变，甚至在一夜之间略有增加。在左锁骨下区域做了一个3厘米的切口，并对其施加负压。干预后数小时皮下气肿完全消退。
由于病程良性，大多数皮下气肿病例（轻度至中度）仅需非手术治疗并同时处理诱发因素。这些患者可能只需要卧床休息、良好的镇痛、补充氧气和安慰。
肺叶切除术后的皮下气肿会延长住院时间。它主要发生在肺功能测试较差、使用类固醇以及粘连广泛的病例中。
