供肺保存的研究现状

供肺保存是肺移植领域中亟待解决的重大课题。近年来供肺保存的研究取得了一定的进展，本文从保存液、保存条件及辅助措施三方面予以总结。     

供肺保存的研究现状

供肺保存是肺移植领域中亟待解决的重大课题。近年来供肺保存的研究取得了一定的进展,本文从保存液、保存条件及辅助措施三方面予以总结。     

肺移植术的供肺保存研究现状

肺移植术是治疗终末期肺疾病的有效方法，而供肺的保存技术关系到肺移植术的成败。而且，这已成为近10年来肺移植研究的焦点。本文就肺移植术中供肺保存的相关问题作一综述。     

肺保存的临床状况及实验研究进展

近十年来,肺移植手术已成为临床终末期肺疾病有效的治疗手段之一。而肺移植的成功与良好的肺保存密切相关。目前,临床上供防保存方法主要有轴心冷却和单纯灌洗,其缺血安全时限仅为6小时。而长时限的成功的肺保存不仅能够增加供肺的来源,而且可以减少排异反应的强度和频度,并为HLA配型提供充裕的时间。为延长缺血的安全时限及改善保存肺的质量,     

保护性有氧肺膨胀与移植肺保护形态学的研究

目的探讨实验性过度肺膨胀对供体肺脏保护的有害影响及肺移植中的保护性肺膨胀。方法杂种犬16只,随机分为对照组和实验组,建立肺过度膨胀动物模型。监测体循环动脉压及中心静脉压,实验组过度肺膨胀,对照组正常肺膨胀均为6h。通过光学显微镜和电子显微镜观察肺组织的病理形态学改变。结果①实验组体循环动脉压和中心静脉压与对照组比较差异无显著性(P>0.05);②病理和超微结构改变:实验组过度膨胀性肺损伤的程度明显大于正常肺膨胀的对照组。结论①超出呼吸生理极限的肺过度膨胀可导致不可逆性肺损伤;②灌注期间应保持供肺的充分膨胀,但不宜过度膨胀,以防止肺泡上皮和肺毛细血管内皮细胞受到不可逆性损伤;③供肺保存过程中应处于保护性肺膨胀状态,即正常膨胀的状态更加符合生理。     

供肺的获取、灌注与保存技术

目前肺移植手术供肺获取后需保存4～6h,即供肺缺血时间不得〉6h。近年来,虽然在动物实验中肺保存时间可长达18～24h,但临床仅有个别报道供肺保存9～12h。延长供肺的保存时间、保持供肺的氧合功能是肺移植成功的保证。因此,对供肺的获取、灌注与保存技术十分重要。     

肺移植现状

肺移植是脏器移植中开展得最晚,并且是移植中最困难的项目。我国的一些医疗单位也在准备开展此项工作.本文对肺移植的发展进行了综述。     

无心跳供体肺移植的研究进展

综述了无心跳供体(non-heart-beating-donor,NHBD)肺移植方面的研究进展,包括NHBD供肺可耐受的缺血时间、针对NHBD供肺的抗凝和溶栓的研究、不同通气模式和吸入药物的影响、供肺保存期间所采取的干预措施如尸体内原位表面冷却以及在保存液中添加各种药物的效果和作用机制等.使用NHBD供肺有望成为缓解供肺短缺的主要解决途径.     

Organ preservation for heart-lung and lung transplantation.

One of the most important restrictions in the field of heart-lung- and lung-transplantation remains the limited ischemic tolerance of the lung. From December 1987 through February 1991, 44 patients underwent either single-, double-, or heart-lung-transplantation. All organs were harvested in multiorgan procedures. For the first 4 patients core cooling of the donor was used. For the rest pulmonary artery flush with modified Euro-Collins solution and prostacyclin was employed. Ischemia time varied from 3-6.5 hours (mean 241; 176-390 minutes). Hearts were arrested with St. Thomas cardioplegia. Oxygenation was satisfactory at 24 hours: p O2 greater than 100 mmHg, FI O2 less than 30% oxygen. It is concluded that for lung preservation modified Euro-Collins solution and prostacyclin for flush perfusion of the pulmonary artery will result in excellent lung function early postoperatively with ischemic times up to 6.5 hours. This method seems advantageous compared to others due to the limited surgical and instrumental needs.     

肺移植围手术期供肺保护的研究新进展

肺缺血再灌注损伤(LIRI)是影响肺移植术后效果的重要因素,肺移植围手术期供肺保护在减轻LIRI方面起着关键作用,本文从肺移植围手术期供肺保护的基础和临床研究取得的新进展如供肺预处理、腺苷受体、一氧化碳和一氧化氮以及体外膜肺氧合的应用等方面作一综述,特别是近几年发展较快的体外肺灌注和基因治疗,旨在为从事临床肺移植供肺保...     

Technical progress in living donor liver transplantation for adults

BACKGROUND: Liver transplantation from a living donor (LDLT) was introduced during the 1990 s to overcome the shortage of donor organs, particularly among children and in those countries in which cadaveric grafts were seldom available. In Japan alone, some 1700 LDLTs were performed in the first 12 years with a 5-year survival rate of 70% in adults and an even higher rate (82%) in children. The major limitation to successful LDLT is inadequate graft size, which usually necessitates the use of the whole right liver unless (I) the caudate lobe is included in a left liver graft, (2) only the right lateral sector is employed (segments VI and VII) or (3) left livers from two donors are implanted into one recipient. DISCUSSION: From a technical standpoint, the main problem with the various types of LDLT has been the venous reconstruction in the recipient. For the left-sided graft, the hepatic vein of the caudate lobe should be re-anastomosed to prevent congestion of this segment. For the right-sided graft, there has been uncertainty about the need to reconstruct the middle hepatic vein (MHV). Implantation is clearly simpler without this additional step, but there is a risk of dysfunction and sepsis in the right paramedian sector. Venous congestion in this sector can be observed during operation, both visually after clamping the MHV and by ultrasonographic assessment of the direction of blood flow in the portal vein. These techniques can be used to determine which patients require bench reconstruction of MHV tributaries or indeed of the inferior right hepatic vein. These manoeuvres should improve graft function and survival.     

肺肿瘤手术治疗的现状与未来

在的常见肺部肿瘤中,肺癌是最常见的肺部原发恶性肿瘤,其发病率和病死率目前已居世界之首。其中大部分为非小细胞肺癌（（non-small cell lung cancer,NSCLC））,小部分为小细胞肺癌（small cell lung cancer,SCLC）,同时肺也是许多其他部位恶性肿瘤最常见的转移部位。     

静脉充氧结合抗氧化剂“复苏”无心跳供肝的实验研究

目的：探讨利用静脉充氧“复苏”较长时间无心跳（热缺血30－60min)供体器官技术进行动物原位肝移植的可行性。方法：36头家猪随机分为供体和受体各3组，供体3组为A组（肝脏热缺血15min),B组（肝脏热缺血60min)和C组（肝脏热缺血60min＋冷保存期供氧），进行动物原位肝移植，观察移植动物的5d生存率，肝细胞损害，肝脏合成功能和全身炎症反应指标的变化。结果：B组供肝组在移植后3h内动物全部死亡，A，C组动物存活至预定观察时间；A，C组动物的肝细胞损害，肝脏合成功能和全身炎症反应指标的变化趋势类似，两组间差异无显著性。结论：冷保存期静脉系统供氧对较长时间热缺血损伤的供体肝脏有一定的保护和复苏作用，有可能成先心跳供肝进行肝移植的辅助方法。     

肺移植术后房颤研究进展

肺移植已成为终末期肺病的主要治疗手段,但肺移植术后房性心律失常的发生率较高,以房颤最为常见.了解肺移植术后房颤的诱发因素及发病机制有助于及早识别高危患者,为指导术后房颤的治疗提供合适方案,从而降低死亡率并改善预后.本文主要对肺移植术后房颤的发生率、危险因素、发病机制、治疗及其对预后的影响进行综述.     

Liver cold preservation induce lung surfactant changes and acute lung injury in rat liver transplantation

AIM:To investigate the relationship between donor liver cold preservation,lung surfactant (LS) changes and acute lung injury (ALI) after liver transplantation.METHODS:Liver transplantation models were estab-lished using male Wistar rats.Donor livers were pre-served in University of Wisconsin solution at 4 ℃ for different lengths of time.The effect of ammonium pyr-rolidinedithiocarbamate (PDTC) on ALI was also detect-ed.All samples were harvested after 3 h reperfusion.The severity of ALI was evaluated by lung weight/body weight ratio,lung histopathological score,serum nitric oxide (NO) and endothelin (ET)-1 levels,lung tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels.Lung surfactants (LSs) were determined by micellar electrokinetic capillary chromatography.RESULTS:With extended donor liver cold preservation time (CPT),lung histopathological scores,serum ET-1 levels,lung weight/body weight ratio and the level of TNF-α and IL-1β in lung were increased significantly in the 180-min group compared with the sham group (3.16 ± 0.28 vs 1.12 ± 0.21,P 0.001;343.59 ± 53.97 vs 141.53 ± 48.48,P 0.001;0.00687 ± 0.00037 vs 0.00557 ± 0.00056,P 0.001;17.5 ± 3.0 vs 1.3 ± 0.3,P 0.001;10.8 ± 2.3 vs 1.8 ± 0.4,P 0.001),but se-rum NO levels decreased remarkably (74.67 ± 10.01 vs 24.97 ± 3.18,P 0.001).The expression of lung phos-phatidylcholine (PC),phosphatidylethanolamine (PE),phosphatidylinositol (PI) and phosphatidylserine (PS) increased when CPT was 120 min,and decreased when CPT was 180 min (PC:1318.89 ± 54.79 vs 1011.18 ± 59.99,P 0.001;PE:1504.45 ± 119.96 vs 1340.80 ± 76.39,P=0.0019;PI:201.23 ± 34.82 vs 185.88 ± 17.04,P=0.2265;PS:300.43 ± 32.95 vs 286.55 ± 55.55,P=0.5054).All these ALI-associated indexes could be partially reversed by PDTC treatment.CONCLUSION:Prolonged CPT could induce or inhibit the expression of LSs at the compensation or decom-pensation stage,and some antioxidants (e.g.,PDTC) may reverse the pathological process partially.     

前列腺素E1对犬心肺联合移植供肺的保护作用

目的研究前列腺素E1（PGE1）在犬心肺联合移植过程中对供肺的保护作用。方法建立犬心肺联合移植模型,先于供体肺动脉内注射PGE1,再在肺动脉内灌注含有PGE1的低温EC（Euro-Collins）溶液,恢复血流灌注后观察实验组及对照组在30、60、90、120 m in的平均肺动脉压（MPAP）、动脉血氧分压（PaO2）的变化,恢复血流灌注1h后,取移植肺组织为标本,检测肺组织中髓过氧化物酶（MPO）活力、肺湿干质量比,HE染色,光镜下观察病理变化。结果实验组中PaO2值在各时间段较对照组明显升高,MPAP值在各时间段较对照组明显降低。实验组肺组织中MPO活性显著低于对照组,实验组的肺湿干质量比较对照组显著降低。病理切片显示对照组的肺组织有较严重的白细胞浸润及肺水肿形成,而实验组的病变程度较对照组轻微。结论在心肺联合移植过程中应用前列腺素E1,可减轻移植肺缺血/再灌注损伤,保护移植肺的肺功能,增加心肺联合移植的成功率。     

经皮射频消融治疗肺癌的现状与进展

在中国,肺癌的发病率和死亡率均居第一位,手术是彻底治愈肺癌的唯一方法,但是临床上只有20％～30％的患者适合手术治疗.近年来,肿瘤物理靶向治疗技术在临床得到广泛应用.肿瘤物理靶向治疗技术是指在微创条件下以肿瘤为目标,最大限度根除靶区的肿瘤细胞及周围1 cm正常组织,以保证根治,最大限度保护正常肺组织.具有微创、安全、适形、并发症少、局麻、操作简单、患者恢复快、可以重复进行、效果可靠等优点,患者易于接受,现已证实是一种有发展前途的治疗手段.目前,国内外常用的肺癌物理靶向技术包括氩氦刀、射频、微波和放射性粒子植入等,笔者对CT引导下射频消融治疗非小细胞肺癌的现状与进展进行了综述.     

NHLBI workshop summary. Biology of lung preservation for transplantation.

The types of animal models that are used for assessing lung preservation, and the types of interventions that are likely to prove of value, must be carefully selected. For example, the events of warm ischemia are not necessarily the same as those that occur during cold preservation. Warm ischemia has often been used as a means of accelerating the degree of ischemic injury, but the events may not be qualitatively the same. Nonetheless, the use of different types of lung injury models contributes to our overall understanding of mechanisms of lung injury associated with transplantation. Pathologic studies of lung injury ischemia and reperfusion may not prove helpful, as they may be nonspecific and insensitive. To compare results of different preservation methods, a standardized animal model would be most helpful if a universally accepted one could be identified. This would include standard measurements of lung function, standard techniques of transplantation, and follow-up studies of several days' duration after transplantation. Such a model could serve as the ultimate test of preservation methods following its development in a variety of the animal models. It must be emphasized that whereas animal models generally begin with a normal lung that is preserved, the clinical situation differs because the donor lungs may be far from normal at the outset due to the effects of brain death, hemodynamic instability, infection, trauma, and a host of other factors. Thus, the limits of safe preservation in a clinical situation may well be significantly less than the safe preservation time demonstrated in the laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)