Refaely Y, Weissberg D
Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Israel.
Ann Thorac Surg. 1997 Oct;64(4):970-3; discussion 973-4. doi: 10.1016/s0003-4975(97)00837-0.
Pulmonary gangrene is a rare complication of severe lung infection with devitalization of lung parenchyma and secondary infection. If untreated, gangrene of the lung leads to sepsis, multiple-organ failure, and death. Resection of all gangrenous tissue is mandatory and is lifesaving. Pleural empyema commonly accompanies gangrene of the lung; in its presence, dissection of hilar structures for resection can lead to mediastinitis or bronchopleural fistula and should be avoided.
Three patients with pulmonary gangrene were treated in two stages: immediate fenestration first and then delayed resection of gangrenous lung in a clean field and immediate closure of the pleural window.
Two patients underwent pneumonectomy and 1 patient, lobectomy. All patients recovered without complications.
Creation of a pleural window (fenestration) for 1 week enables safe and curative resection of a gangrenous lung or lobe in a clean field and in a patient in stable condition.
肺坏疽是严重肺部感染的一种罕见并发症，伴有肺实质坏死和继发感染。若不治疗，肺坏疽会导致败血症、多器官功能衰竭及死亡。切除所有坏疽组织是必要的，也是挽救生命的措施。肺坏疽常伴有胸膜腔积脓；存在胸膜腔积脓时，为切除而解剖肺门结构可导致纵隔炎或支气管胸膜瘘，应避免。
3例肺坏疽患者分两阶段治疗：先立即开窗，然后在清洁术野中延迟切除坏疽肺组织，并立即封闭胸膜窗。
2例行全肺切除术，1例行肺叶切除术。所有患者均康复，无并发症。
创建胸膜窗（开窗）1周可使坏疽肺或肺叶在清洁术野及病情稳定的患者中得到安全且根治性的切除。
