| Ruijie Zhang,yixin Cai,Shengling Fu,Xiangning Fu,Ni Zhang. Middle lobe torsion after right upper and lower lobectomy: repositioning of lobar torsion using a 3-cm uniportal video-assisted thoracoscopic surgery. Oncol Transl Med, 2017, 3: 38-40. |
| 胸腔镜下扭转肺叶复位及牵引固定术治疗术后中叶扭转的探索 |
| Middle lobe torsion after right upper and lower lobectomy: repositioning of lobar torsion using a 3-cm uniportal video-assisted thoracoscopic surgery |
| Received:July 05, 2016 Revised:January 19, 2017 |
| DOI：10.1007/s10330-016-0169-9 |
| 中文关键词: 中叶扭转，复位，3cm单孔胸腔镜 |
| 英文关键词: lobe torsion; 3-cm uniportal; video-assisted thoracoscopic surgery (VATS) |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Ruijie Zhang | Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China | jerry_zhang@tjh.tjmu.edu.cn | | yixin Cai | Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China | yixin28@qq.com | | Shengling Fu | Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China | t0102005@126.com | | Xiangning Fu | Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China | fuxn2006@aliyun.com | | Ni Zhang* | Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China | zhangnidoc@gmail.com |
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| 中文摘要: |
| 目的
肺扭转是临床上罕见的疾病，以肺实质绕肺门支气管或血管蒂旋转为特征。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。肺扭转的临床表现及影像学缺乏典型的特征，很难及时做出诊断和处理，从而导致错过最佳的治疗时机。肺扭转的治疗以切除扭转肺叶为最常用方式。我科尝试了胸腔镜下扭转肺叶复位术治疗肺扭转，预后良好，没有增加并发症，且保留了更多的肺叶，值得进一步探索其可行性。
材料和方法
患者，男，74岁，因右上肺肿块伴纵膈淋巴结转移，侵犯下肺静脉，行右上肺及下肺切除术，术后第一天复查胸片，中叶复张良好，患者咳痰较差，经纤支镜吸痰，可见大量黄色浓痰自中叶涌出。术后第5天患者诉胸闷加重，但咳痰较少，听诊右肺呼吸音消失，予以纤支镜吸痰，见中叶狭窄，未见明显痰液，急行胸部CT，提示右肺不张，结合病史，诊断为中叶扭转可能。
胸腔镜探查，见胸腔大量积液，中叶成大约60°扭转，肺叶色泽尚良好，未见明显坏死表现，以卵圆钳复位，麻醉医生经气管插管可吸出大量黄色浓痰，膨肺良好。将中叶顺自然方向摆正，丝线结扎中叶边缘，牵引固定于前纵隔方向。
结果
术后第2天复查胸部CT肺复张良好，术后经纤支镜吸痰，可见中叶大量黄色浓痰涌出，支气管通畅良好。术后2月，复查胸部CT，中叶复张良好。
结论
肺叶切除术后肺扭转，早期发现与诊断至关重要，如无明显肺缺血坏死，可尝试胸腔镜下扭转肺叶复位及牵引固定术，以保留更多的肺组织，保护患者肺功能。但进一步的推广，仍需更多的病例数据支持。 |
| 英文摘要: |
| We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal
video-assisted thoracoscopic surgery (VATS) approach. Middle lobe torsion occurred after right upper and
lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal
VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest
wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest
radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an
unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography
was performed 3 months after the primary surgery and revealed increased expansion of the right middle
lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but
more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment
option for such cases. |
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