肺移植术后支气管吻合口裂开行二次肺移植1例  

Secondary lung transplantation for bronchial anastomosis dehiscence in one patient

作　　者：杨建辉[1] 赵高峰[1] 丁志丹[1] 王跃斌[1] 李丰科[1] 刘晓飞[1] 赵凯 YANG Jianhui;ZHAO Gaofeng;DING Zhidan;WANG Yuebin;LI Fengke;LIU Xiaofei;ZHAO Kai(Department of Lung Transplant and Thoracic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan450052,China)

机构地区：[1]郑州大学第一附属医院肺移植外科/胸外科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第7期699-703,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：郑州市科技协同创新专项(XTCX2023009)。

摘　　要：目的 探讨1例肺移植后支气管吻合口裂开患者行二次肺移植的疗效及安全性。方法 1例支气管肺泡细胞癌患者,男,66岁,2023年5月21日于郑州大学第一附属医院行序贯式同种异体原位双肺移植术,术后2周康复出院。2023年6月14日住院复查,期间患者突发胸痛、胸闷、呼吸困难、血压下降、意识障碍,给予气管插管等措施抢救,转入ICU治疗4 h后突发右侧张力性气胸,紧急胸腔闭式引流出大量气体。行CT及气管镜检查,确诊为右侧支气管吻合口裂开。多学科会诊评估内科治疗及介入治疗效果差,经家属同意后拟行右肺移植,再次加入肺移植等待系统。2023年6月21日于全身麻醉、静脉-动脉体外膜肺氧合辅助下行同种异体原位右肺移植。记录二次肺移植手术情况及术后恢复情况。结果 手术时间230 min,支气管吻合及包埋时间45 min,动脉吻合时间18 min,左房袖吻合时间12 min,术中出血量400 mL,冷缺血时间315 min。术后第1天体外膜肺氧合撤机,术后第2天呼吸机撤机,继续给予高流量吸氧,术后第11天转入普通病房治疗,术后第38天顺利康复出院,无术后并发症发生。术后第2、3个月复查胸部CT,提示患者肺膨胀良好。随访至2024年5月,患者继续康复中。结论 二次肺移植治疗肺移植后支气管吻合裂开安全、有效,可使患者获益。Objective To investigate the outcome and safety of secondary lung transplantation for bronchial anastomosis dehiscence after lung transplantation in one patient. Methods A male 66-year-old patient with bronchoalveolar cell carcinoma was performed sequential allograft orthotopic double lung transplantation in the First Affiliated Hospital of Zhengzhou University on May 21, 2023, and was recovered and discharged 2 weeks after operation. On June 14, 2023, he developed suddenly chest pain, chest distress, dyspnea, decreased blood pressure and consciousness disorder during hospitalization review, and was transferred to ICU after tracheal intubation and other rescue treatment. Four hours later, he was found right tension pneumothorax burst, and emergency closed thoracic drainage was given to drain a large amount of gas. CT examination and tracheoscopy confirmed the right bronchial anastomosis dehiscence. The multidisciplinary consultation suggested the medical treatment and interventional treatment were ineffective. After his family members agreed, he was enrolled in the lung transplant waiting system for secondary lung transplantation. On June 21, 2023, allogeneic orthotopic right lung transplantation was performed under general anesthesia assisted by veno-arterial extracorporeal membrane oxygenation. The procedures of the scondary lung transplantation and the postoperative recovery were recorded. Results The operation lasted for 230 min, with the bronchial anastomosis and embedding time of 45 min, arterial anastomosis time of 18 min, left atrial sleeve anastomosis time of 12 min, intraoperative blood loss of 400 mL, and cold ischemia time of 315 min. Veno-arterial extracorporeal membrane oxygenation was withdrawn on postoperative day 1,the mechanical ventilation was weaned on postoperative day 2,and high-flow oxygen was continuously given.The patient was transferred to the regular ward on postoperative day 11,and was discharged on postoperative day 38.No postoperative complications occurred.The chest CT scan 2and 3mo

关 键 词：肺移植 支气管吻合口裂开 二次肺移植 

分 类 号：R655.3[医药卫生—外科学]