- 期刊
Reduction of Lobar Torsion after Thoracoscopic Lobectomy: Report of a Case
經胸腔鏡復位之左上肺葉切除後肺扭轉：案例報告
摘要
胸腔鏡手術後肺葉扭轉是一種罕見但有高死亡率風險的致命性術後併發症。對於胸腔手術的術後照護，如何迅速且正確地辨識肺葉扭轉的徵象相當重要。然而，當病患生命徵象穩定，無明顯休克、敗血症或肺水腫表現的情況下，要適切的診斷出肺扭轉在臨床上仍極具挑戰性。在此，我們要報告的案例是一位83歲男性，因健檢發現左上肺野陰影，經切片確診為非小細胞肺癌，入院施行胸腔鏡左上肺葉切除與淋巴結廓清。術後胸部放射線序列檢查表現逐漸擴大的肺葉塌陷。在術後第二日的斷層掃描以及支氣管鏡檢查，直接觀察到肺血管與支氣管的扭轉，確診為左下肺扭轉。經緊急胸腔鏡復位手術後，恢復良好順利出院。
並列摘要
Lobar torsion after thoracic surgery is a rare but life-threatening complication with reported high morbidity and mortality. Recognition of this complication may be difficult, especially if signs of infarction, such as shock, sepsis and interstitial pulmonary edema are lacking. Herein, we present the case of an 83-year-old male with lung cancer who underwent video-assisted thoracoscopic surgery (VATS) for a left upper lobectomy and mediastinal lymphadenectomy. Since postoperative serial chest roentgenogram showed progressive opacity of the left lung field, chest computed tomography (CT) and bronchoscopy were arranged on postoperative day (POD) 2, and revealed total obstruction of the left lower bronchus. Under the impression of lobar torsion, we performed emergency thoracoscopic reduction surgery immediately thereafter, and successfully rescued the affected lobe.