肺移植手术28例

The clinical experience of 28 cases with lung transplantation

目的回顾性总结探讨28例终末期肺疾病肺移植手术患者的临床处理经验及影响因素。方法2005年8月至2010年12月行终末期肺疾病肺移植手术28例，其中双肺移植13例，单肺移植15例。肺灌注采用LPD液顺行灌注＋逆行灌注。移植吻合过程中经食管超声和Swans导管实时监测肺动脉压力和流速。术后于呼吸重症监护室治疗，根据血药浓度调整免疫抑制药物用量。结果全组无术后支气管吻合口瘘或狭窄等气道并发症。肺移植围手术期（30天）死亡2例（7．2％），术后1、2和3年的累积生存率分别为94．1％、76．2％和71．4％。肺移植术后90天内死亡4例（14．3％）。术中因肺动脉狭窄重新吻合3例（3支）。术后开胸止血2例，开胸切除肺大疱1例。随访1．0—6．1年，生存者生活质量良好。结论加强围手术期处理、提高手术技术不仅有利于减少手术相关并发症、降低术后早期死亡比例，也对肺移植术后的远期生存起至关重要的作用。术中食管超声检查可以早期发现血管吻合的异常情况。而术后密切随访和康复治疗对于减少远期气道并发症、防治闭塞性细支气管炎、提高生存质量有益。

Objective To discuss the clinical experience and influence factors of airway complications after lung trans- plantation for end-stage lung diseases through reviewed 28 lung transplantation cases in our center. Methods From August 2005 to December 2010, 28 patients with end-stage lung diseases received lung transplantations consecutively in our center, in which 13 patients were bilateral-lung transplantation（BLT） and 15 patients were single-lung transplantation（SLT）. The donor lungs were perfused with LPD solution antegrade and retrograde followed. During operation, the pulmonary artery pressure and flow rate were tested real time through the transesophageal echocardiography and Swans catheter. Postoperative care of patients was in respiratory intensive care unit, and immunosuppressive drugs were adjusted according to blood drug concentration. Re- suits There were no airway complications including anastomotic fistula or stenosis found in all patients. The mortality was 7.2% in the early postoperative period （ 1 - 30 days）. Cumulative survival rate was 94.1% % at 1 year, 76.2% at 2 years, and 71.4% at 3 years respectively. Four patients （ 14.3% ） died in the postoperative 90 days. Three patients were reanasto- mosed pulmonary artery in operation because of stenosis detected by transesophageal echocardiography. After operation, three patients were reoperated, in which two were bleeding and one was pulmonary bulla and pneumothorax. All patients were fol- lowed from 1 year to 6. l years after operation. The quality of life was improved significantly. Conclusion The well improved technique of lung transplantation is helpful to reduce the operation related complications, decrease the early mortality post oper- ation and play the important role in the effects of quality of life and long term survival rate. The intraoperative transesophageal echocardiography examination could detect the anomalous situation of vascular anastomosis. At the same time the patients should get benefits from the routine and close follow-up.