同种异体单肺移植7例报告
동충이체단폐이식7례보고
Allogeneic single lung transplantation in 7 cases
  • 万方数据
    中国组织工程研究与临床康复 중국조직공정연구여림상강복
    JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
    2008年 53期 10567-10570 ,共4页

    刘德若%郭永庆%赵风瑞%李福田%葛炳生%石彬%田燕雏%宋之乙%寿延宁%张海涛%梁朝阳%王在永%陈京宇%鲍彤%张真榕%辛育龄

    류덕약%곽영경%조풍서%리복전%갈병생%석빈%전연추%송지을%수연저%장해도%량조양%왕재영%진경우%포동%장진용%신육령

    肺移植%器官保存%并发症%器官移植 肺移植%器官保存%併髮癥%器官移植
    폐이식%기관보존%병발증%기관이식
    Lung transplantation%lung preservation%complication%organ graft
    总结7例同种异体单肺移植资料的移植方案、肺保存及移植后管理监测情况.7例同种异体单肺移植患者中特发性肺纤维化3例,慢性阻塞性肺病2例,双侧矽肺、肺气肿1例,双肺结核右毁损肺1例.7例供体均为脑死亡者,供肺均采用Euro,Colins液或低钾右旋糖酐液灌注并良好保存.受体与供体血型匹配,5例患者行右侧单肺移植,2例行左侧单肺移植.肺支气管、肺动脉为端端吻合,肺静脉为心房-心房吻合.移植前后均常规应用抗牛素和免疫抑制剂.肺移植后进行全面指标监测,包括心肺功能、抗生素使用及免疫抑制药物的调整.7例患者均未出现支气管、肺动静脉吻合口并发症.5例移植后2个月内死亡,1例存活近1年,另1例存活近2年.死亡者中4例死于肺感染导致多脏器功能衰竭,1例死于多曲霉菌感染致严重肺出血.6例移植后出现排斥反应,其中1例出现3次.肺移植手术适应证的选择、供肺的选择和保存、肺移植操作以及移植前后的管理已逐渐成熟,移植前心肺功能差者、移植后使用免疫抑制药物同时合并严重感染者病死率仍很高.
    총결7례동충이체단폐이식자료적이식방안、폐보존급이식후관리감측정황.7례동충이체단폐이식환자중특발성폐섬유화3례,만성조새성폐병2례,쌍측석폐、폐기종1례,쌍폐결핵우훼손폐1례.7례공체균위뇌사망자,공폐균채용Euro,Colins액혹저갑우선당항액관주병량호보존.수체여공체혈형필배,5례환자행우측단폐이식,2례행좌측단폐이식.폐지기관、폐동맥위단단문합,폐정맥위심방-심방문합.이식전후균상규응용항우소화면역억제제.폐이식후진행전면지표감측,포괄심폐공능、항생소사용급면역억제약물적조정.7례환자균미출현지기관、폐동정맥문합구병발증.5례이식후2개월내사망,1례존활근1년,령1례존활근2년.사망자중4례사우폐감염도치다장기공능쇠갈,1례사우다곡매균감염치엄중폐출혈.6례이식후출현배척반응,기중1례출현3차.폐이식수술괄응증적선택、공폐적선택화보존、폐이식조작이급이식전후적관리이축점성숙,이식전심폐공능차자、이식후사용면역억제약물동시합병엄중감염자병사솔잉흔고.
    The present case report was designed to summarize the clinical experience of operative technique. lung preservation, lung perfusion, and perioperative management. Of 7 cases who underwent allogenic single lung transplantation (LT), 3 were idiopathic pulmonary fibrosis, 2 were chronic obstructive pulmonary disease, 1 was silicosis, emphysema, and bulla, and I was tuberculosis in both sides and presented with destroyed lung in one side. All donors were already brain death. Donor lungs were well preserved utilizing Euro-Colins liquid or low-potassium dextran solution. Donors and recipients were matched in blood type. Of 7 cases selected,5 received single right lung transplantation, and 2 received single left LT. End-to-end anastomosis was performed for pulmonary branches and pulmonary arteries. while atrium-to-atrium anastomosis was performed for pulmonary vein. Antibiotics and immunosuppressants were routinely used prior to and subsequent to LT. Following LT, heart and lung function, usage of antibiotics, and adjustment of immunosuppressant were monitored. Stomal complications regarding bronchus and pulmonary artery and vein did not appear in any patient. Five cases survived for about 2 months, one for approximately 1 year, and one for nearly 2 years. Four cases died of multi-organ failure caused by pulmonary infection, and one of severe pulmonary hemorrhage caused by aspergillus sydowi infection. Rejection occurred in 6 cases. One case sufiered from rejection three times. Selection of indication, selection and preservafton of donor lung, LT operation and pre-and post-operative management of LT have acquired satisfactory achievements. High mortality occurred in patients with preoperative poor cardiac and pulmonary functions and postoperative severe infections accompany with application of immunosuppressant.
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