同种异体原位心脏移植(附11例报告)

Orthotopic heart transplantation:11 cases report

目的总结同种异体原位心脏移植的手术经验。方法对11例终末期心脏病患者施行同种异体原位心脏移植术。其中标准原位心脏移植术1例，双腔静脉吻合法原位心脏移植术10例，心肾联合移植术1例。5例术前存在中度肺动脉高压者，术中及术后给予一氧化氮（NO）吸入等措施治疗。抗排异治疗采用环孢素A（CsA）＋甲基强的松龙（MP）＋霉酚酸酯（MMF）三联方案。结果2例术后出现急性排异反应．给予大剂量MP冲击治疗3d缓解；1例术后第3天出现肾功能衰竭．给予血液透析后缓解。1例行心肾联合移植术者术后18d死于肺动脉栓塞。随访6～45个月，晚期死亡2例，其余病例心功能正常，恢复正常工作和生活。结论严格掌握受体适应证、合适的手术方法及严格的围术期管理可提高同种异体原位心脏移植术的疗效。

Objective To explore the experience of orthotopic heart transplantation, [Methods]11 patients with end-stage cardiomyopathy were treated with orthotopic heart transplantation（1 with conventional stanford cardiac transplanlation and 10 with bicaval anastomotic cardiac transplantation, 1 underwent heart and kidney transplantation）. 5 patients with moderate pulmonary hypertension were treated with inhalation of NO during and after opevation. All cases were prescribed with Cyclosporine A ＋ Corticosteroids ＋ MMF. [Results] 2 patient with acute rejection were treated with Medrol and hemodialysis respectively. 1 patient with heart and kidney transplantation died at 18th day for thrombus of pulmonary. During 6 - 45 months follow-up, 2 patients died, others resumed daily work. [Conclusion ]The operative result of heart transplantation can be improved by accurate selection for recipient,suitable surgical procedure and accurate management of peri-operation.