肺移植手术切口发展历程和研究现状  

Development course and research status of incisions in lung transplantation

作　　者：徐坚 邵景博 陈员 卫栋 叶书高 陈静瑜 Xu Jian;Shao Jingbo;Chen Yuan;Wei Dong;Ye Shugao;Chen Jingyu(Wuxi Medical Center,Nanjing Medical University,Wuxi People's Hospital,Department of Lung Transplant Center,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学无锡医学中心无锡市人民医院南京医科大学附属无锡人民医院肺移植中心,江苏无锡214023

出　　处：《器官移植》2024年第4期637-642,共6页Organ Transplantation

基　　金：国家自然科学基金面上项目(82070059);无锡医学中心揭榜挂帅项目(WXKY202301001)。

摘　　要：肺移植手术技术对于受者的临床预后有着显著的影响,选择合适的手术切口决定了术中的视野暴露,是手术顺利进行的第一步,直接影响后续的手术进程。肺移植切口通常默认一期关闭,但对于肺移植术毕存在如供肺过大、原发性移植物失功等高危因素患者,不能一期关闭切口,此时延迟关胸是一种应对策略。肺移植手术切口的选择及是否延迟关闭,对于肺移植围手术期预后、受者远期生存质量、手术并发症有着深远的影响。因此,本文结合国内外文献对肺移植Clamshell切口、前外侧切口、后外侧切口、胸骨正中切口的发展和研究现状进行综述,聚焦切口对肺移植预后的影响,为临床肺移植手术切口选择提供参考。Surgical technique of lung transplantation exerts significant impact on clinical prognosis of the recipients.Choosing an appropriate surgical incision determines the exposure of intraoperative visual field,which is the first step of surgical success and directly affects subsequent surgical procedures.Lung transplantation incision is usually considered as primary closure.Nevertheless,for patients with high-risk factors such as oversized lung allografts and primary graft failure after lung transplantation,primary closure cannot be achieved.Hence,delayed chest closure is an effective strategy.The selection of incisions and the adoption of delayed chest closure of lung transplantation exert profound impact upon perioperative prognosis,long-term quality of life and surgical complications of the recipients.Therefore,the development and research status of Clamshell incision,anterolateral incision,posterolateral incision and median sternal incision in lung transplantation were reviewed,highlighting the effect of incision patterns on clinical prognosis of lung transplantation and providing reference for the selection of incisions in clinical lung transplantation.

关 键 词：肺移植 手术入路 Clamshell切口 前外侧切口 后外侧切口 胸骨正中切口 延迟关胸 手术部位感染 

分 类 号：R617[医药卫生—外科学] R563[医药卫生—临床医学]