不横断胸骨双侧前胸切口双肺移植

Bilateral sequential lung transplantation through bilateral anterolateral thoracotomy without sternal division

目的探讨不横断胸骨双侧前胸切口序贯式双侧单肺移植的可行性及手术技术。方法2004年12月至2005年3月,为3例终末期肺病患者进行了不横断胸骨双侧前胸切口序贯式双侧单肺移植。供肺均以改良的棉子糠LPD液灌注保存;手术时间分别为9.5h、6.5h和8.5h;第1和第2个植入供肺的冷缺血时间分别为195/465、250/330和250/440min。结果受者术后脱离呼吸机的时间分别为6、11和10d;ICU病房停留时间分别为9、16和13d;康复出院时间分别为41、67和30d。没有1例发生影响伤口愈合的并发症。结论双侧前胸切口不横断胸骨开胸双肺移植,手术创伤小,且安全可靠,减少了胸骨愈合的并发症,术后恢复快,有助于患者术后肺功能的提高,值得在我国进一步推广应用。

Objective To discuss the operative technique and possibility of bilateral sequential single-lung transplantation （BSLT） through bilateral anterolateral thoracotomy without sternal division. Methods Three recipients with end-stage diseases received bilateral sequential single-lung transplantation through bilateral anterolateral tboracotomy without sternal division in our hospital from Dec. 2004 to March 2005. The surgical procedures used were similar to those mentioned in the literature. The donor lung was perfused by Raffinose-LPD solution. The operative time was 9. 5,6. 5 and 8. 5 h respectively. The difference between the ischemic time of the first and second lungs was 195/465 rain, 250/330 and 250/440 min respectively. Results Intensive care unit stay was 9, 16 and 13 days respectively. The hospital stay was 41, 67 and 30 days respectively. No wound related complication was observed. Conclusions The bilateral anterolateral thoracotomy without sternal division is a safe and effective approach for BSLT. It allows avoiding sternal complications and contributes to improve respiratory function in the early postoperative period.