同种异体单肺移植六例报告  

Allograft lung transplantation in 6 cases

作　　者：刘德若[1] 郭永庆[1] 赵凤瑞[1] 李福田[1] 葛炳生[1] 石彬[1] 田燕雏[1] 宋之乙[1] 寿延宁[1] 张海涛[1] 梁朝阳[1] 王在永[1] 陈京宇[1] 鲍彤[1] 辛育龄[1] 

机构地区：[1]中日友好医院胸外科,北京100029

出　　处：《北京医学》2006年第8期449-451,共3页Beijing Medical Journal

摘　　要：目的总结6例肺移植手术的方法、肺保存及术后管理监测。方法选择1996～2005年进行的6例同种异体肺移植,其中男5例,女1例,平均年龄53.6岁;特发性肺纤维化3例,慢性阻塞性肺病(COPD)2例,双肺结核右毁损肺1例。供肺均为脑死亡,采用Euro-Colins或LPD液肺灌注并良好保存。受体与供体血型匹配,均行右肺移植,肺支气管、肺动脉为端端吻合,肺静脉为心房-心房吻合,手术前后均常规应用抗生素和免疫抑制剂,术后全面监测,包括心肺功能、抗生素使用及免疫药物的调整。结果本组未出现支气管、肺动静脉吻合口并发症。6例中5例术后2个月死亡,1例存活近1年。死亡者中4例死于肺感染导致多脏器功能衰竭,1例死于严重肺出血。6例术后均出现排斥反应,其中1例术后出现2次。结论肺移植手术适应证的选择、供肺的选择和保存、手术操作以及手术前后的管理已逐渐成熟,术前心肺功能差者、术后使用免疫药物同时合并严重感染者病死率仍很高。Objective To investigate feasibility of allograft lung transplantation and summarize clinical experiences of operative techniques, lung preservation and infusion and also the postoperative management and monitoring. Methods Between 1996 to 2005, 6 patients with a median age of 53.6 years, underwent allograft lung transplantation, including 5 males and 1 female. 3 patients were with idiopathic pulmonary fibrosis, 2 with COPD and the other one with bilateral pulmonary fibrosis and right-lateral damaged lung. All donors were already brain dead. We used Euro-colins or LPD liquid for perfusion and preservation of the lungs. Blood Group compatibility were matched between donors and receipts. All patients underwent right lateral lung transplantation. Antibiotics and immunosuppressive drugs were generally used preoperatively. All aspects of monitoring were used postoperatively, including cardiopulmonary function, usage of antibiotics and ajust of immunosuppressive drugs. Results In this group, there was no anastomotic complication of bronchus, pulmonary arteries and veins. In this 6 patients, 5 survived less than 2 months after transplantation, 1 survived longer than 1 and half year. In the 5 patients who survived less than 2 months, 4 died of MODS caused by pulmonary infection and 1 died of severe pulmonary hemorrhage. Rejection happened postoperatively in all 6 patient, which attacked 3times in one petient. Conclusions Lung transplantation is a kind of study that needs multiple discipline cooperation. Though it is difficult, the selection of indication, the choose and presentation of donor lung, operation techniques as well as perioperative management and monitoring are gradually normalized. In those patients who had severe cardiopulmonary function impairment as well as mortality is still high in those who acquired severe infection with the usage of immunosuppressive drugs postoperatively.

关 键 词：肺移植 肺保存 并发症 

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