左肺移植联合右肺减容积术围术期治疗体会  

Report of left lung transplantation in combination with right lung volume reduction in one case

作　　者：林江波[1] 康明强[1] 陈舒晨[1] 林培裘[1] 林若柏[1] 林英[1] 

机构地区：[1]福建医科大学附属协和医院胸外科福建省胸心外科研究所,福州350001

出　　处：《中国综合临床》2007年第12期1100-1102,共3页Clinical Medicine of China

基　　金：福建省科技厅科技计划重点项目(2006Y0015)

摘　　要：目的总结1例左肺移植联合右肺减容积术围术期治疗的体会。方法为1例慢性呼吸衰竭患者施行同种异体左肺移植术+同期右肺减容积术。结果患者术后48 h脱离呼吸机。但于第3天和第4天因左、右侧胸腔先后出现活动性出血而分别行剖胸止血。第6天出现急性排斥反应,激素冲击后缓解。第14天因移植肺细菌感染加重予加强抗感染治疗。第20天并发术后器官精神综合征。第30天移植肺继发真菌感染,经伏立康唑治疗后好转。第60天发现左主支气管吻合口狭窄,行射频消融治疗。结论正确的围术期处理是肺移植患者长期存活的关键,重点是防治移植肺早期失功能和围术期的感染。Objective To summarize the perioperative management of left lung transplantation in combination with right lung volume reduction in one case. Methods Left lung transplantation in combination with right lung volume reduction was performed in a case of end-stage respiratory failure. Results The patient was successfully extubated 48 hours after operation, Postoperative hemothoraxs occured and reoperation in left side of thoracic cavity was performed 3 days later and in right side 4 days later. Acute allograft rejection occurred 6 days later. The patient responded promptly by administering a bolus dose of methylprcdnisolone. The transplanted lung was susceptible to bacterial infection 14 days later,then appropriate broad-spectrum antibiotic therapy was administered. The recipient developed the postoperative organic mental syndromes 20 days after surgery. Fungal infection of the transplanted lung occurred 30 days later and was successfully treated by Voriconazole. Bronchoscopic evaluation of the airway found the stenosis of the left main bronchus 60 days later. Treatment of the entity was performed satisfactorily with radiofrequency ablation. Conclusion Corrective perioperative management plays a major role in the long-term survival of lung transplantation recipient. Prevention of early graft dysfunction and perioperative infection are important in ensuring an early successful outcome.

关 键 词：肺移植 同种异体 肺减容积术 

分 类 号：R655.3[医药卫生—外科学]