序贯式双肺移植九例报告  

Clinical practice of 9 cases of bilateral sequential lung transplantations

作　　者：施建新[1] 高成新[1] 秦元[1] 胡定中[1] 曹克坚[1] 杨骏[1] 

机构地区：[1]上海交通大学附属胸科医院胸外科,200030

出　　处：《中华器官移植杂志》2006年第2期68-71,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨9例序贯式双肺移植的手术指征和安全性。方法自2003年1月至2005年6月，共进行了9例序贯式双肺移植。2例受者在第1侧肺植入后恢复通气和灌注，再作第2侧肺的切除和植入；6例在第1侧肺植入后使用体外膜氧合（ECMO），再完成第2侧肺的切除和植入；1例在体外循环（CPB）下完成，同时使用一氧化氮（NO）吸入。结果前2例患者术中出现严重的移植肺水肿，术后仅生存12和36h。使用ECMO的6例患者均安全渡过手术关，术后移植肺氧合良好，拔除口插管时间为36～72h，平均为48h，其中4例患者顺利恢复出院，最长已生存16个月，1例术后1个月死于肺部感染大咯血，1例术后3周死于肾功能衰竭。使用CPB的1例患者术中死于大量渗血和严重的酸中毒。结论序贯式双肺移植手术指征较广，但手术风险大；使用ECMO可显著提高手术的安全性。Objective To explore the surgical indications and safety of bilateral sequential lung transplantation in 9 cases. Methods Between Jan. 2003 to June 2005, 9 bilateral sequential lung transplantations were performed in Shanghai Chest Hospital. In 2 cases, the resection and re-transplantation of the second lung was done after ventilation and perfusion in the first lung transplantation. In 6 cases, after the first lung was transplanted, ECMO was established with heparin-bonded circuitry and centrifugal pump and the second lung was transplanted. In 1 case, CPB was used during the transplantation of the second lung. Meanwhile, inhaled nitric oxide （INO） therapy （40 ppm） was performed in 7 cases. Results Severe lung edema occurred in 2 cases, and the patients survived only 12 and 36 h respectively. Six cases with ECMO thereafter rided out the operation successfully. Postoperative days ventilated were 36 to 72 h （mean 48 h）. Four patients of them discharged in good conditions and have survived 16, 14, 11, 9 months respectively. One patient died of pulmonary infection and emptysis one month after operation. Another patient died of acute renal failure 3 weeks after operation. The operation performed under the support of CPB was unsuccessful because of heavy hemorrhage and severe acidosis. Conclusions Bilateral sequential lung transplantation is a high risk procedure. ECMO can reduce the risk significantly. Inhaled nitric oxide during and after operation is of benefit to stabilization of hemodynamics and reduce ischemic reperfusion injury.

关 键 词：肺移植 体外膜氧合作用 

分 类 号：R655.3[医药卫生—外科学] R657.505[医药卫生—临床医学]