3例肺移植术后肺部感染的防治体会  

Control of Postoperative Pulmonary Infection in Lung Allotransplantation(a report of 3 cases)

作　　者：陈舒晨[1] 康明强[1] 林江波[1] 林若柏[1] 林培裘[1] 陈椿[1] 李伟[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：《福建医科大学学报》2009年第2期163-165,共3页Journal of Fujian Medical University

基　　金：福建省科技厅重点资助项目(2006Y0015)

摘　　要：目的总结3例同种异体肺移植术后肺部感染防治的经验和教训。方法2005年6月-2008年10月在非体外循环下右单肺移植术治疗终末期肺气肿1例(受体1)、单肺移植同期对侧肺减容术治疗终末期肺气肿1例(受体2)、体外循环下双肺移植术治疗终末期矽肺1例(受体3)。结果3例手术基本顺利,受体1术后第4天出现移植肺感染,第7天出现急性排斥反应和左侧自体肺感染,术后2年10月伴发左下肺炎性肌纤维母细胞瘤,存活至今。受体2术后第6天出现急性排斥反应,左侧声带麻痹和声音嘶哑,反复并发严重的移植肺细菌感染、霉菌感染和吻合口狭窄;术后9月因双肺严重感染并移植肺慢性排斥反应而死亡。受体3双肺移植术后未出现排斥反应,但多次伴发肺部感染,出现桥脑中央髓鞘溶解症,存活33天。结论合理强度的免疫抑制治疗和合理的抗生素应用是肺移植术后感染防控和患者长期存活的关键,纤维支气管镜是肺移植术后感染防控的有效方法。Objective To summarize the experience on control of postoperative pulmonary infection based on studies of 3 cases with lung allotransplantation. Methods Three patients with end-stage pulmonary diseases underwent lung transplantation from 2005 to 2008 in our hospital. The types of sur- gery included right lung transplantation in 1 patient （receptor 1） with end-stage pulmonary emphysema, left lung transplantation with synchronized contralateral lung volume reduction in 1 patient （receptor 2） with final stage emphysema, and double-lung transplantation by extracorporeal circulation in 1 patient （receptor 3） with end-stage silicosis. Results Three recipients all survived their transplantation. For receptor 1, infection of the graft lung occurred at day 4 after lung transplantation, so did acute rejection and infection of the left autologous lung at day 7. In addition, inflammatory myofibroblastic tumor of lung was present 2 years and 10 months later. Up to now, receptor 1 has led a life of good quality for 3 years and 4 months. For receptor 2, acute rejection, left vocal cord paralysis, and hoarseness took place at day 6 after lung transplantation, repeatedly complicated with severe bacterial infection, fungal infection and anastomotic stenosis. Receptor 2 died of severe infection of double lungs complicated with chronic rejection. For receptor 3, rejection was absent after double-lung transplantation, but pulmonary infection was detected many times. The recipient survived for 33 days, and died of supervene central pontine myelinolysis. Conclusion Reasonable immune inhibition therapy along with rational application of antibiotics is the key to the control of postoperative infection in lung allotransplantation, and bronchofiberscope makes an effective means in this respect.

关 键 词：肺移植 肺炎 肺疾病 阻塞性 肿瘤 肌组织 手术后并发症 支气管镜检查 感染控制 移植物排斥 

分 类 号：R655.3[医药卫生—外科学]