手工缝合肺残面施行肺减容手术治疗重度肺气肿

目的 探讨手工缝合肺残面方法肺减客手术治疗重度慢性阻塞性肺气肿的疗效。方法 本组肺减容手术20例，其中双侧肺减容6例，单侧肺减容14倒。切口的选择依据手术切除靶区的位置，其中平卧位正中切口、双侧LVRS1例，侧卧住后外侧开胸LVRS14侧，前外侧开胸LVRS11侧。术前及术后6月查肺功能（FEV1，TLC，RV）、动脉血气分析、6分钟步行距离进行对比。结果 本组无手术死亡，患者术后肺功能指标比术前有明显改善（P〈0．05），动脉血氧分压术后比术前明显提高（P〈0．05），二氧化碳分压术后比术前明显降低（P〈0．05）；呼吸困难指数再分级，15例术前3级中6例转为1级，9例转为2级；5例4级中1例转为3级，3例转为2级，1例转为1级。结论 重度肺气肿病人行肺减容手术，能改善患者肺功能，提高生活质量。     

肺减容术治疗重度肺气肿的临床观察

目的 评价胸腔镜下肺减容手术治疗晚期重度肺气肿病人的治疗效果.方法 选择37例病人进行肺减容手术,术后6个月复查肺功能及6min步行距离,并将结果 与术前对比,评价疗效.结果 术后死亡1例,其余病人均痊愈出院.术后6个月复查肺功能及6min步行距离,与术前相比有明显差异(P＜0.05).结论 肺减容手术可以明显改善病人肺功能,提高病人生活质量.     

肺减容手术治疗肺气肿

肺气肿是慢性阻塞性肺病 (COPD)的一种类型。其治疗措施包括 :内科保守治疗、肺功能锻炼和肺移植 ,前两者疗效不佳 ,后者国外大量开展 ,并取得一定的疗效 ,但肺供体来源有限 ,需长期使用免疫抑制剂 ,肺减容手术 (L VRS)作为替代肺移植的手段已越来越受到人们的关注。〔1 0 ,1 1〕1　历史背景1945年 ,Nissen首次报导局部切除肺大泡组织 ,术后症状明显改善〔1〕。 1975年 Brantigan倡导切除肺周围肺气肿组织的手术方式 〔2〕,经后外侧切口 ,连续楔形切除可疑肺气肿最严重的部位 (约占肺容积的 2 0 %～ 30 % ) ,其认为 :通过减少肺容积可增…     

终末期肺气肿肺减容术的各种影像学检查比较及进展

肺气肿是慢性阻塞性肺疾病的一种常见临床表现,特点是不可逆性的终末气道的扩张和肺泡壁损害.肺减容术主要应用于终末期肺气肿患者,主要原理是切除部分无功能的肺组织来提高肺组织的弹性回缩力、横膈的运动功能及改善循环通气血流比.虽然心肺功能可以通过1秒用力呼气容积等进行检查,但是肺气肿的分布、异质性、严重程度及肺功能变化需要影像学及放射性核素评价,比如计算机断层显像、肺通气/灌注显像等,这些检查各自具有优势,同时又相互补充,对术前患者的选择及术后疗效的评估具有重要价值.     

肺移植供肺获取100例：冷缺血时间>6 h及肺减容对预后的影响*

背景：肺移植过程中供肺获取的手术技巧、冷缺血时间的上限以及供肺与受者胸腔大小不匹配等问题的处理有待进一步研究。 目的：总结肺移植中供肺获取的手术技巧,探讨冷缺血时间和肺减容对受者移植后各种并发症以及生存率的影响。 方法：回顾分析100例供肺获取和101例受者的临床资料,根据供肺冷缺血时间所有受者分为冷缺血时间< 6 h组或> 6 h组;另根据移植中是否出现供肺与受者胸腔大小不匹配分为肺减容组和对照组,不匹配的均行不同方式肺减容。分析冷缺血时间>6 h和肺减容对肺移植患者预后的影响。 结果与结论：100例供肺获取和101例肺移植均成功,其中1供者的左右肺分别移植给2例受者,共完成101例肺移植。除供肺冷缺血时间>6 h组原发性移植物失功发生率要高于< 6 h组(P < 0.05)外,其他各指标差异均无显著性意义(P > 0.05);肺减容组与对照组各临床指标差异亦无显著性意义(P > 0.05)。提示严格的供者选择、恰当的供肺减容以及尽量缩短供肺冷缺血时间可以有效防止受者移植后各种并发症的发生,提高肺移植成功率,改善患者预后。 关键词：肺移植;脑死亡;供者选择;器官保存液;围手术期 doi:10.3969/j.issn.1673-8225.2012.05.018     

同期心脏和肺移植6例

背景：心肺移植目前仍然是治疗终末期心肺疾病的最好方法,但由于诸多原因国内的供者短缺是一个很严峻的问题。 目的：观察利用同一供者对不同受者同期进行心、肺移植的可行性。 方法：将3例供者的心脏、肺脏分别同期移植给3例相同血型的终末期心脏疾病受者和3例终末期肺脏疾病受者,观察移植效果。 结果与结论：6例患者中有1例双肺移植患者出现右肺上叶静脉栓塞于术后第9天再次手术切除后痊愈,术后30 d出院。1例双肺移植患者1个月出现感染经对症治疗后好转,于术后2个月出院。1例心脏移植患者出现早期肾功能衰竭,经血液透析治疗后痊愈出院。余3例患者均安全渡过围手术期后痊愈出院,到目前有3例仍有很好的生活质量。提示利用同一供者的心、肺分别给不同受者进行心、肺移植,能充分利用供者,缩短受者等待时间。     

肺移植患者的康复护理

目的探索肺移植患者术前后的康复护理.方法通过术前评估了解患者的综合状况进行分析,并针对问题做好患者心理康复护理,术前后康复护理和出院康复指导.结果医护紧密配合,3例患者顺利成功接受了移植手术,术后恢复良好,肺功能检查显示比术前明显改善.生活完全自理,已投入社会工作.结论 3例肺移植患者的康复过程,是护理思路和做法一个良好开始,康复过程存在的问题还需我们在实践中去解决和不断创新,使肺移植患者的生存质量不断提高.[关健词] 肺移植;护理;康复     

胸腔镜下双侧同期肺减容术的护理

探讨胸腔镜下重度肺气肿双侧同期减容术的护理措施及临床意义.①总结8例重度肺气肿双侧同期减容术的护理措施:术前加强健康教育及心理护理,进行呼吸运动训练,作好呼吸道准备;术后严密观察生命体征,有效叩背排痰,保持呼吸道通畅;对术后主要的并发症重点防治;进行康复训练和出院前指导.②8例均于肺功能改善状态下步行出院.术后第1、3、6、10月随访,肺功能逐步好转,6分钟活动能力提高,胸片示膈肌形态有改善.     

单孔胸腔镜肺楔形切除术和单孔胸腔镜解剖性肺段切除术治疗早期肺癌的效果

目的 比较单孔胸腔镜肺楔形切除术和单孔胸腔镜解剖性肺段切除术治疗早期肺癌的临床效果。方法 回顾性分析我院收治的90例早期肺癌患者的临床资料,根据手术方式不同将患者分为楔形组(n=43,行单孔胸腔镜肺楔形切除术)和肺段组(n=47,行单孔胸腔镜解剖性肺段切除术)。比较2组患者手术相关指标及术后1 d、2 d、3 d的疼痛情况。记录2组患者术前及术后3个月第1秒用力呼气量(FEV1)、最大通气量(MVV)、用力肺活量(FVC)等肺功能相关指标。记录2组患者术后并发症发生情况及术后3年生存情况。结果 与肺段组相比,楔形组患者的手术时间、术后留管时间及术后住院时间更短,术中出血量、术后胸腔引流量更少,差异均有统计学意义(P<0.05)。楔形组患者术后1 d、2 d、3 d的疼痛VAS评分明显低于肺段组(P<0.05)。术后3个月,2组患者肺功能指标均较术前显著下降,但楔形组的肺功能指标均高于肺段组,差异均有统计学意义(P<0.05)。楔形组并发症总发生率低于肺段组(P<0.05)。术后随访8～36个月,2组患者术后3年总生存率比较差异无统计学意义(P>0.05)。...     

胸腔镜下双侧同期肺减容术的护理

探讨胸腔镜下重度肺气肿双侧同期减容术的护理措施及临床意义。（1）总结8例重度肺气肿双侧同期减容术的护理措施；术前加强健康教育及心理护理，进行呼吸运动训练，作好呼吸道准备；术后严密观察生命体征，有效叩背排痰，保持呼吸道通畅；对术后主要的并发症重点防治；进行康复训练和出院前指导；（2）8例均于肺功能改善状态下步行出院，术后第1、3、6、10月随访，肺功能逐步好转，6分钟活动能力提高，胸片示膈肌形态有改善。     

Single lung transplantation--one year follow-up

Lung transplantation is now generally accepted as a modality of care for patients with end-stage lung diseases who demonstrate declining of lung function despite optimal therapy. This paper describe a case of single lung transplantation performed in patient with advanced obstructive pulmonary diseases and pulmonary fibrosis. One year follow-up with special regard to complications after operation is presented.     

Evaluation of visceral impairments by exercise testing: practice and problems in recently-developed exercise testing in disabled patients and an introduction of a newly-developed instrument for monitoring cardiopulmonary and postural parameters

OBJECTIVE: Exercise testing plays a major role in evaluation of visceral impairments in disabled patients. We introduced recently-developed exercise testing and a newly-developed instrument for monitoring cardiopulmonary and postural parameters. We also evaluated the effects of cardiac phase II rehabilitation, pulmonary rehabilitation, and lung volume reduction surgery (LVRS) in patients with cardiopulmonary diseases. METHODS: 1) The ratio of ischemic heart disease in stroke patients was assessed by exercise testing. 2) The physical status of the patients with myocardial infarction (MI) was assessed before and just after our hospitalized cardiac phase II rehabilitation program, and at a 6-month follow-up by cardiopulmonary exercise testing. 3) The physical status of the patient with idiopathic interstitial pneumonia was assessed before and after pulmonary rehabilitation by a six-minute walking test. 4) The physical status of the patients with pulmonary emphysema (PE) was assessed before and 3 months after LVRS. 5) We introduced a newly-developed instrument for monitoring cardiopulmonary and postural parameters (MCPP). RESULTS AND CONCLUSIONS: The ratio of ischemic heart disease (IHD) in stroke patients was 18%. Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the physical status in patients with MI. The physical status of the patient with idiopathic interstitial pneumonia was markedly improved after pulmonary rehabilitation, and she did not need to undergo lung transplantation. The physical status and lung function of PE was significantly improved 3 months after LVRS. MCPP was made and used in the field of rehabilitation medicine. MCPP shows the picture and cardiopulmonary and postural parameters at the same time on a monitor, and is a very useful tool to evaluate the activities of daily living of the patients undergoing rehabilitation. MCPP may provide useful information to develop more efficient strategies for rehabilitation planning and patients' education.     

Lung transplantation in patients with pulmonary emphysema

Lung transplantation is a viable option for patients with chronic obstructive pulmonary disease (COPD), and emphysema is the most common indication to undergo lung transplantation. A total of seven lung and one heart-lung transplantations were performed between July 1996 and June 2004 at the Yongdong Severance Hospital, and herein, three emphysema patients who underwent single lung transplantations are reviewed. There were 2 males and 1 female, with a mean age of 50 years (35, 57 and 58 years). They all underwent an operation, without cardiopulmonary bypass, and there was no operative mortality. The mean survival was 12 months (4 months, 15 months and 17 months) and all succumbed to death due to activation of pulmonary tuberculosis, post-transplantation lymphoproliferative disease and cytomegalovirus (CMV) gastritis associated with asphyxia. Infection was the most common postoperative complication, resulting in longer hospital stays, higher medical expenses and shorter survival rates, necessitating aggressive prophylactic management. The accumulation of experience, modifications to operative procedures and perioperative care may lead to improved early and long-term survival in patients with emphysema undergoing single or bilateral lung transplantations.     

Heart transplantation in adults with congenital heart disease: experience with 15 patients

End-stage congenital heart disease (CHD) is an important indication for pediatric heart transplantation (HTx) as well as transplantation in adult populations. The purpose of this retrospective analysis was to compare the survival rate of adults who underwent HTx for end-stage CHD with those who underwent HTx for other causes. To find out whether HTx is a viable therapeutic option for adult patients with preoperated CHD, data from 15 adult patients with different forms of CHD, who had previously undergone different corrective and palliative procedures, were retrospectively analyzed and compared with the HTx data of 1400 adult patients (>15 years old) whose indications for HTx were other than end-stage CHD. From 1989 to 2005, 15 adult patients (eight men/seven women) were given transplantation for end-stage CHD. Ten patients had been preoperated once, five patients twice. Their mean age was 34.06 +/- 3.9 years. In five cases, patients had development of acute renal failure. One female patient died 40 days after surgery, after having a cerebral infarction; one male patient died 4 years after HTx for OKT 3 monoclonal antibody-resistant rejection; and two patients died as the result of multiple organ failure at 4 days and 30 days after HTx, respectively; 11 patients are still alive. The cumulative survival rate at 1 year is 80% versus 80% in patients given transplantation for noncongenital indications. Heart transplantation in adults with end-stage CHD can be performed with a good long-term prognosis. Previous palliative operations do not affect outcome after HTx.     

Results of single-lung transplantation for bilateral pulmonary fibrosis. The Toronto Lung Transplant Group

Between November 1983 and August 1989, we performed single-lung transplantation for end-stage pulmonary fibrosis in 20 patients. Nine patients (45 percent) who survived for more than one year form the basis of this report. Before surgery, the nine survivors had severe restrictive lung disease, with a mean (+/- SD) vital capacity (VC) of 43 +/- 9 percent, a forced expiratory volume in one second (FEV1) of 50 +/- 9 percent, and a single-breath diffusing capacity (DLCO) of 36 +/- 9 percent of predicted values. One year after transplantation, the patients' VC had reached 69 +/- 10 percent, FEV1 79 +/- 15 percent, and DLCO 62 +/- 16 percent of predicted values. Relative perfusion to the transplanted lung rose from 63 +/- 14 percent (three days after surgery) to 77 +/- 7 percent within three months and stayed constant or increased slightly thereafter. Before surgery, despite supplemental oxygen at flow rates varying from 1 to 9 liters per minute, none of the patients could exercise beyond stage 1/2 (2.7 km [1.7 miles] per hour, 5 percent grade) on a modified Bruce treadmill-exercise protocol. All eight patients tested one year or more after transplantation achieved at least stage 1 (2.7 km [1.7 miles] per hour, 10 percent grade), and usually a higher stage, without supplemental oxygen. Arterial oxygen tension returned to normal values in most patients (87 +/- 13 mm Hg), and supplemental oxygen, which all patients required before surgery, was no longer needed by any patient after transplantation. We conclude that in carefully selected patients with end-stage pulmonary fibrosis, single-lung transplantation is an effective treatment.     

Spirometric Assessment of Lung Transplant Patients: One Year Follow-Up

OBJECTIVE:

The purpose of this study was to compare spirometry data between patients who underwent single-lung or double-lung transplantation the first year after transplantation.

INTRODUCTION:

Lung transplantation, which was initially described as an experimental method in 1963, has become a therapeutic option for patients with advanced pulmonary diseases due to improvements in organ conservation, surgical technique, immunosuppressive therapy and treatment of post-operative infections.

METHODS:

We retrospectively reviewed the records of the 39 patients who received lung transplantation in our institution between August 2003 and August 2006. Twenty-nine patients survived one year post-transplantation, and all of them were followed.

RESULTS:

The increase in lung function in the double-lung transplant group was more substantial than that of the single-lung transplant group, exhibiting a statistical difference from the 1st month in both the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) in comparison to the pre-transplant values (p <0.05).Comparison between double-lung transplant and single lung-transplant groups of emphysema patients demonstrated a significant difference in lung function beginning in the 3rd month after transplantation.

DISCUSSION:

The analyses of the whole group of transplant recipients and the sub-group of emphysema patients suggest the superiority of bilateral transplant over the unilateral alternative. Although the pre-transplant values of lung function were worse in the double-lung group, this difference was no longer significant in the subsequent months after surgery.

CONCLUSION:

Although both groups demonstrated functional improvement after transplantation, there was a clear tendency to greater improvement in FVC and FEV1 in the bilateral transplant group. Among our subjects, double-lung transplantation improved lung function.     

Functional evaluation of lung by Xe-133 lung ventilation scintigraphy before and after lung volume reduction surgery (LVRS) in patients with pulmonary emphysema

We evaluated the respiratory functions of patients with pulmonary emphysema who underwent lung volume reduction surgery (LVRS) by the mean transit time (MTT) with Xe-133 lung ventilation scintigraphy, forced expiration volume in 1 sec (FEV1.0), residual volume (RV), distance walked in 6 min (6-min walk), and the Hugh-Jones classification (H-J classification) before and after LVRS. In 69 patients with pulmonary emphysema (62 men, 7 women; age range, 47-75 years; mean age, 65.4 years +/- 6.1, preoperative H-J classification, III (two were II)-V) who underwent LVRS, all preoperative and postoperative parameters (MTT 3 weeks after LVRS and the others 3 months after LVRS) were judged statistically by the Wilcoxon signed-ranks test and Odds ratio. Every postoperative parameter was improved with a significant difference (P < 0.05) compared to preoperative parameters. MTT at 3 weeks after LVRS was not associated with %FEV1.0 and the H-J classification at 3 months after LVRS, but was associated with RV and a 6-min walk at 3 months after LVRS. MTT was useful for the clinical evalution of aerobic capability after LVRS.     

大鼠肺移植模型的改良

背景：建立大鼠原位肺移植模型是研究肺移植后慢性排异反应的关键,但因其需要精细外科技术,难度较大,限制了这一模型的应用。 目的：改良麻醉和肺移植过程,建立快速、安全、具有可重复性的大鼠肺移植模型。 方法：共完成42只大鼠动物实验,供体受体各21只。采用胸骨正中切口解剖供体左肺并置入套管(用静脉留置针套管剪取1.5 mm长制成)获取大鼠供肺。大鼠受体经左侧开胸,利用套管技术吻合完成供肺植入。记录并计算手术时间及移植成功率。 结果与结论：移植后大鼠均存活,大鼠供肺获取时间平均为(35.3±5.1) min;供肺套管时间平均为(12.5±    4.6) min;大鼠受体肺移植时间平均为(50.2±3.3) min;吻合时间平均为(27.7±6.2) min。开放肺动、静脉血流后,全肺迅速变红,血流灌注充分,静脉回流通畅;恢复机械通气后,所有移植肺膨胀良好。结果证实,改良后的麻醉和肺移植技术可为大鼠肺移植的免疫与排异研究提供稳定、可靠、可重复的动物模型。