同种异体肺移植围手术期X线片改变的临床意义及处理  

Clinical significance and treatment in perioperative lung transplantation patients with abnormal radiographic findings

作　　者：杨骏[1] 高成新[1] 赵学维[2] 秦元[1] 胡定中[1] 施建新[1] 曹克坚[1] 

机构地区：[1]上海市胸科医院胸外科,200031 [2]第二军医大学附属长征医院胸心外科

出　　处：《上海医学》2006年第7期417-419,F0002,共4页Shanghai Medical Journal

摘　　要：目的探讨同种异体肺移植手术患者围手术期胸部X线片改变对临床诊断和治疗的意义。方法15例患者行肺移植手术,男11例,女4例；肺淋巴管平滑肌瘤病4例,肺纤维化3例,矽肺2例,双肺弥漫性支气管扩张症3例,慢性阻塞性肺气肿3例。单例肺移植6例；序贯式双侧肺移植9例,死亡4例。结果胸部X线片改变包括：缺血再灌注损伤3例,急性排异反应5例,肺部感染1例,移植肺过度通气1例,急性心包填塞1例,吻合口狭窄2例,移植肺受压性肺不张1例。根据影像学资料及时明确临床诊断并予积极治疗后,上述患者均安全度过围手术期。结论围手术期的胸部影像学改变对于临床诊断及相应治疗具有重要的指导意义。Objective To appraise the significance of radiographic findings on the diagnosis and management of patients undergone lung transplantation. Methods 15 patients with end-stage lung disease underwent lung transplantation in our hospital, with 11 males and 4 females, including diseases of lymphangioleiomyomatosis （LAM） 4, pulmonary fibrosis 3, silicosis 2, bronchiectasis 3, and chronic obstructive pulmonary disease（COPD） 3. We performed unilateral lung transplantation in 6 patients and bilateral sequential lung transplantation in 9 pa tients; among these, 3 died during the surgical procedure. Results The causes of abnormal radiographic findings were; ischemic-reperfusion injury in 3 cases; acute pulmonary rejection in 5; pulmonary infection in 1; overventilation of the allograft and pericardial tamponade in 1; anastomotic stricture in 2; compressive atelectasis of transplanted lung in 1. All patients passed through the perioperative period smoothly owing to the prompt radiography. Conclusion Perioperative radiography is an important measure in the diagnosis and early treatment of the patients undergoing lung transplantation.

关 键 词：同种异体肺移植 胸部影像学改变 围手术期 处理 

分 类 号：R655.3[医药卫生—外科学] R734.2[医药卫生—临床医学]