心肺联合移植11例单中心经验

目的总结心肺联合移植经验。 方法回顾性分析2015年9月至2018年11月广州医科大学附属第一医院完成的11例心肺联合移植受者临床资料。男性7例，女性4例，平均年龄(32±11)岁。原发病为艾森曼格综合征3例，特发性肺动脉高压4例，复杂先天性心脏合并肺血管病变、肺动脉栓塞、双肺移植术后心肺功能衰竭及扩张型心肌病合并慢性阻塞性肺疾病各1例。供者选择参照肺移植及心脏移植标准。11例受者均采用胸骨正中切口，经主动脉和上、下腔静脉远端插管建立体外循环，切除受者心肺后，植入供肺和供心，依次吻合气管、主动脉、上腔静脉及下腔静脉。 结果11例受者中，4例术后30 d内死亡，其中2例死于胸腔及纵隔出血，2例死于脑血管并发症；术后30 d至1年死亡3例，死因为排斥反应引起的移植物功能障碍及感染、移植物功能障碍导致的多器官功能衰竭。术后1年有4例受者存活。 结论严格选择供、受者以及术中后纵隔彻底止血可显著降低心肺联合移植手术死亡率，提高受者术后生存率及生存时间。

Eleven cases of heart-lung transplantation: a single centre experience

ObjectiveTo summarize the clinical experience of heart-lung transplantation. MethodsThe clinical data of 11 cases of heart-lung transplantation (7 for male and 4 for female ) who got transplantation in the First Affiliated Hospital of Guangzhou Medical University from September 2015 to November 2018 were retrospectively ananlysed. The mean age of 11 recipients was (32±11). The primary diseases included 3 cases of Eisenmenger′s syndrome, 4 cases of idiopathic pulmonary arterial hypertension, and one in each of complex congenital heart disease, pulmonary embolism, cardiopulmonary failure after double lung transplantation, and cardiomyopathy with chronic obstructive pulmonary disease. The selection of donor heart and lung were according to the criteria of lung and heart transplantation. Median sternotomy were used in all cases. Cardiopulmonary bypass was established by aortic, distal superior and inferior vena cava cannulation. Diseased heart and lung were excised before donor heart and lung implantation, and then with trachea, aorta, superior and inferior vena cava anastomosis in turn. ResultsOf the 11 recipients, 4 recipients died within 30 days after operation, among which 2 recipients died of pleural and mediastinal hemorrhage, and 2 recipients died of cerebral complication; 3 recipients died during 30 days to 1 year after operation, the cuses of death were graft dysfunction and infection caused by rejection, and multiple organ failure caused by graft dysfunction. The remaining 4 recipients were still alive during 1 year after transplantation. ConclusionsStrict selection of donors and recipients and complete haemostasis for postmediastinum during transplantation can reduce surgical mortality of heart-lung transplantation and improve the survival rate and time of recipients significantly.