Spontaneous anterior thoracic lung hernias
Spontaneous anterior thoracic lung hernias
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DOI：
10.1016/s0022-5223(00)70103-6
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发表时间：
2000-05-01
影响因子：
6
通讯作者：
Heitmiller, RF
中科院分区：
文献类型：
--
作者：
Brock, MV;Heitmiller, RF
讨论历史上，无损伤的肺疝被归类为“自发性”。从技术上讲，这个术语是一个误称，因为自发性肺疝通常是胸内压力突然增加的结果，伴随着咳嗽，打喷嚏，唱歌，举重，或吹乐器导致肋骨或软骨骨折。自1968年以来，包括我们的2例患者，已经报道了16例自发性前肺疝（表I）。患者年龄范围为19 - 76岁，平均58.4岁。所有患者均为男性。右侧和左侧肺疝的发生频率相同。50%的患者有吸烟史，5例患者（31%）肥胖。主要体征和症状包括隆起（16/16，100%）、隆起部位疼痛（14/16，87%）和瘀斑（7/16，44%）。典型的临床病史是咳嗽或打喷嚏后的急性胸壁疼痛。急性评估显示胸部X线片显示肋骨骨折，体格检查显示胸壁瘀斑。急性疼痛消退，并发展为慢性疼痛性胸壁隆起。14例病例提供了治疗信息。14例患者中有12例（86%）接受了手术修复。2例患者（14%）接受了非手术治疗，包括桁架绷带、镇痛药、止咳药、止吐药和减重。在我们的综述中，手术适应症最常见的是疼痛性隆起（14/16，87.5%）。我们认为，手术适用于所有的前肺疝，即使是无症状的，以避免疝延伸到腹壁导致胸腹疝。胸腹疝的发病率及其修补的复杂性均高于单纯的前肺疝。在我们的综述中，16例患者中有7例（44%）成功完成了无假体材料的前肺疝一期手术修复（表I）。我们更倾向于使用修补补片来闭合缺损，恢复肋缘连续性，并重新连接腹部筋膜。标准胸壁
Discussion. Herniation of the lung without an antecedent injury is historically classified as “spontaneous.” Technically, the term is a misnomer because spontaneous lung hernias are generally the consequence of a sudden increase in intrathoracic pressure that accompanies coughing, sneezing, singing, heavy lifting, or blowing into a musical instrument resulting in rib or cartilage fracture.Since 1968, including our 2 patients, there have been 16 reported cases of spontaneous anterior lung hernias (Table I). Patient ages ranged from 19 to 76 years with a mean of 58.4 years. All patients were male. Lung hernias occurred with equal frequency on the right and left sides. Fifty percent of patients gave a history of smoking and 5 patients (31%) were obese. Cardinal signs and symptoms included a bulge (16/16, 100%), pain at the site of the bulge (14/16, 87%), and ecchymosis (7/16, 44%). The classic clinical history is acute chest wall pain after coughing or sneezing. Acute evaluation shows rib fractures on chest film and chest wall ecchymosis on physical examination. The acute pain resolves and a chronic, painful chest wall bulge develops. Information regarding therapy was provided in 14 cases. Twelve of 14 patients (86%) underwent surgical repair. Two patients (14%) were treated nonoperatively with truss bandages, analgesics, cough suppressants, anti-emetic agents, and weight reduction. The indication for surgery in our review was most commonly a painful bulge (14/16, 87.5%). We believe that surgery is indicated for all anterior lung hernias, even if asymptomatic, to avoid extension of the hernia onto the abdominal wall resulting in a thoracoabdominal hernia. The morbidity of thoracoabdominal hernias and the complexity of their repair are both greater than with anterior lung hernias alone. Primary surgical repair of anterior lung hernias without prosthetic material was successfully accomplished in 7 of 16 patients (44%) in our review (Table I). We prefer to use a prosthetic patch to close the defect, restore costal margin continuity, and reattach the abdominal fascia. Standard chest wall