François B, Desachy A, Cornu E, Ostyn E, Niquet L, Vignon P
Intensive Care Unit, Dupuytren University Hospital, Limoges, France.
J Trauma. 1998 Jan;44(1):217-9. doi: 10.1097/00005373-199801000-00035.
The therapeutic management of lung herniation, an uncommon complication of severe blunt chest trauma, remains controversial. We report here on two cases of traumatic lung herniation with different, yet successful, methods of therapeutic management according to the particular anatomic types. Because of the threat of tension pneumothorax, incarceration, or strangulation of the lung parenchyma in mechanically ventilated patients, surgical reduction of intercostal pulmonary hernias with narrow necks is usually recommended. In contrast, supraclavicular pulmonary hernias secondary to clavicle-sternal dislocation may be treated conservatively with serial clinical and thoracic imaging follow-up including chest computed tomographic scan. In this anatomical type of lung herniation, favorable spontaneous evolution is frequently observed, presumably because of the presence of a larger thoracic wall defect together with the absence of associated perforating bone trauma. The efficacy of the therapeutic approach proposed herein remains to be confirmed by further experience.
肺疝是严重钝性胸部创伤的一种罕见并发症，其治疗管理仍存在争议。我们在此报告两例创伤性肺疝病例，根据特定的解剖类型采用了不同但成功的治疗方法。由于机械通气患者存在张力性气胸、肺实质嵌顿或绞窄的风险，通常建议对颈部狭窄的肋间肺疝进行手术复位。相比之下，锁骨 - 胸骨脱位继发的锁骨上肺疝可通过包括胸部计算机断层扫描在内的系列临床和胸部影像学随访进行保守治疗。在这种解剖类型的肺疝中，经常观察到良好的自然转归，推测是因为胸壁缺损较大且无相关的穿通性骨创伤。本文提出的治疗方法的疗效仍有待进一步经验证实。
