肺叶切除术后肺扭转的诊治及预防进展

Lung Torsion after Lobectomy:Diagnosis,Treatment and Prevention

肺扭转是临床罕见的疾病,以肺实质绕其近端支气管或血管蒂向单方向发生旋转为特征。根据旋转程度的不同可导致不同的后果,轻者可出现扭转肺组织的血流动力学改变,重者出现肺内淤血、梗死、全身中毒症状、缺血缺氧、呼吸衰竭、严重感染乃至死亡。其发生原因有多种,包括胸外科手术后肺扭转、胸部钝性外伤后肺扭转、肺炎后肺扭转、气胸、胸腔积液导致的肺扭转以及肺移植术后肺扭转等。其中以胸外科手术后,尤其是肺叶切除术后肺扭转最为常见,好发于右肺中叶。但因该病缺乏典型的临床表现,较难与其它疾病相鉴别,常不能得到早期诊断、干预和治疗,病死率极高。现对肺扭转的发病率、发病原因、临床表现、诊断、预防和治疗进行综述。

Lung torsion is a very rare clinical event and characterized by rotation of entire lung or individual lobes around the proximal bronchus or blood vessel pedicle in a single direction. The outcomes of lung torsion vary according to different rotation degree. Mild lung rotation may cause hemodynamic changes of the rotated pulmonary tissue. Severe lung rotation may lead to pulmonary venous congestion, lung infarction, systemic intoxication symptoms, ischemia, hypoxia, respiratory failure, severe infection or even death. There are a number of causes of lung torsion, including thoracic surgery, blunt chest trauma, pneumonia, pneumothorax, pleural effusion and lung transplantation. The majority of lung torsion cases occur after thoracic surgeries especially lobectomy, with the right middle lobe being most easily endangered after right upper lobectomy. Lung torsion does not have typical clinical manifestations and thus is difficult to be differentiated from other diseases. Patients with lung torsion often cannot receive correct diagnosis, proper intervention and treatment in time, which may lead to a high mortality. This review focuses on the morbidity, pathogenesis, clinical manifestations, diagnosis, prevention and treatment of lung torsion.