中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2012年
3期
138-140,151
,共4页
苗劲柏%侯生才%李辉%胡滨%代华平%李彤%王洋%游宾%傅毅立%陈其瑞%张文谦
苗勁柏%侯生纔%李輝%鬍濱%代華平%李彤%王洋%遊賓%傅毅立%陳其瑞%張文謙
묘경백%후생재%리휘%호빈%대화평%리동%왕양%유빈%부의립%진기서%장문겸
肺移植%终末期肺疾病%吻合%手术技术
肺移植%終末期肺疾病%吻閤%手術技術
폐이식%종말기폐질병%문합%수술기술
Lung transplantation%End-stage lung diseases%Anastomosis%Operation technique
目的 回顾性总结探讨28例终末期肺疾病肺移植手术患者的临床处理经验及影响因素.方法 2005年8月至2010年12月行终末期肺疾病肺移植手术28例,其中双肺移植13例,单肺移植15例.肺灌注采用LPD液顺行灌注+逆行灌注.移植吻合过程中经食管超声和Swans导管实时监测肺动脉压力和流速.术后于呼吸重症监护室治疗,根据血药浓度调整免疫抑制药物用量.结果 全组无术后支气管吻合口瘘或狭窄等气道并发症.肺移植围手术期(30天)死亡2例(7.2％),术后1、2和3年的累积生存率分别为94.1％、76.2％和71.4％.肺移植术后90天内死亡4例(14.3％).术中因肺动脉狭窄重新吻合3例(3支).术后开胸止血2例,开胸切除肺大疱1例.随访1.0～6.1年,生存者生活质量良好.结论 加强围手术期处理、提高手术技术不仅有利于减少手术相关并发症、降低术后早期死亡比例,也对肺移植术后的远期生存起至关重要的作用.术中食管超声检查可以早期发现血管吻合的异常情况.而术后密切随访和康复治疗对于减少远期气道并发症、防治闭塞性细支气管炎、提高生存质量有益.
目的 迴顧性總結探討28例終末期肺疾病肺移植手術患者的臨床處理經驗及影響因素.方法 2005年8月至2010年12月行終末期肺疾病肺移植手術28例,其中雙肺移植13例,單肺移植15例.肺灌註採用LPD液順行灌註+逆行灌註.移植吻閤過程中經食管超聲和Swans導管實時鑑測肺動脈壓力和流速.術後于呼吸重癥鑑護室治療,根據血藥濃度調整免疫抑製藥物用量.結果 全組無術後支氣管吻閤口瘺或狹窄等氣道併髮癥.肺移植圍手術期(30天)死亡2例(7.2％),術後1、2和3年的纍積生存率分彆為94.1％、76.2％和71.4％.肺移植術後90天內死亡4例(14.3％).術中因肺動脈狹窄重新吻閤3例(3支).術後開胸止血2例,開胸切除肺大皰1例.隨訪1.0～6.1年,生存者生活質量良好.結論 加彊圍手術期處理、提高手術技術不僅有利于減少手術相關併髮癥、降低術後早期死亡比例,也對肺移植術後的遠期生存起至關重要的作用.術中食管超聲檢查可以早期髮現血管吻閤的異常情況.而術後密切隨訪和康複治療對于減少遠期氣道併髮癥、防治閉塞性細支氣管炎、提高生存質量有益.
목적 회고성총결탐토28례종말기폐질병폐이식수술환자적림상처리경험급영향인소.방법 2005년8월지2010년12월행종말기폐질병폐이식수술28례,기중쌍폐이식13례,단폐이식15례.폐관주채용LPD액순행관주+역행관주.이식문합과정중경식관초성화Swans도관실시감측폐동맥압력화류속.술후우호흡중증감호실치료,근거혈약농도조정면역억제약물용량.결과 전조무술후지기관문합구루혹협착등기도병발증.폐이식위수술기(30천)사망2례(7.2％),술후1、2화3년적루적생존솔분별위94.1％、76.2％화71.4％.폐이식술후90천내사망4례(14.3％).술중인폐동맥협착중신문합3례(3지).술후개흉지혈2례,개흉절제폐대포1례.수방1.0～6.1년,생존자생활질량량호.결론 가강위수술기처리、제고수술기술불부유리우감소수술상관병발증、강저술후조기사망비례,야대폐이식술후적원기생존기지관중요적작용.술중식관초성검사가이조기발현혈관문합적이상정황.이술후밀절수방화강복치료대우감소원기기도병발증、방치폐새성세지기관염、제고생존질량유익.
Objective To discuss the clinical experience and influence factors of airway complications after lung transplantation for end-stage lung diseases through reviewed 28 lung transplantation cases in our center.Methods From August 2005 to December 2010,28 patients with end-stage lung diseases received lung transplantations consecutively in our center,in which 13 patients were bilateral-lung transplantation(BLT) and 15 patients were single-lung transplantation(SLT).The donor lungs were perfused with LPD solution antegrade and retrograde followed.During operation,the pulmonary artery pressure and flow rate were tested real time through the transesophageal echocardiography and Swans catheter.Postoperative care of patients was in respiratory intensive care unit,and immunosuppressive drugs were adjusted according to blood drug concentration.Results There were no airway complications including anastomotic fistula or stenosis found in all patients.The mortality was 7.2％ in the early postoperative period ( 1-30 days).Cumulative survival rate was 94.1％ ％ at 1 year,76.2％ at 2 years,and 71.4％ at 3 years respectively.Four patients (14.3％) died in the postoperative 90 days.Three patients were reanastomosed pulmonary artery in operation because of stenosis detected by transesophageal echocardiography.After operation,three patients were reoperated,in which two were bleeding and one was pulmonary bulla and pneumothorax.All patients were followed from 1 year to 6.1 years after operation.The quality of life was improved significantly.Conclusion The well improved technique of lung transplantation is helpful to reduce the operation related complications,decrease the early mortality post operation and play the important role in the effects of quality of life and long term survival rate.The intraoperative transesophageal echocardiography examination could detect the anomalous situation of vascular anastomosis.At the same time the patients should get benefits from the routine and close follow-up.
