双肺移植术后支气管吻合口狭窄的治疗体会

目的 总结肺移植术后支气管吻合口狭窄的治疗经验。方法 1例接受双肺移植术的患者术后发生双侧支气管吻合口粘膜坏死和狭窄。经过13个月的球囊导管扩张（22次）和激光烧灼治疗（5次），效果不显著，术后11个月。在使用异丙酚的情况下结合局部麻醉行硬气管镜治疗，用不同口径的中金属空圆柱管做扩张器，左侧治疗2次，右侧治疗3次。结果 左侧支气管吻合口直径维持在8-10mm，以后未再扩张，右侧扩张效果差，右上支气管开口闭死，右中间干虽能勉强扩开，但造影证实其远端以下支气管管腔闭死，后因右肺的反复炎症，不得已行右全肺切除，切下的右肺及支气管壁均有结核病变。现患者一般情况尚可，生活自理。结论 肺移植术后的支气管吻合口狭窄与术后支气管缺血，大剂量使用激素和结核感染有关，应早期在神志镇静，局部麻醉下通过气管镜对狭窄进行治疗，中空金属圆柱状扩张器的效果优于单纯的球囊扩张。

The treatment of stenosis of both anastomosis of bronchus after bilateral lung transplantation

Objective To study the treatment of stenosis of both anastomosis of bronchus after bilateral lung transplantation.Methods One patient with mucosal necrosis and stenosis in both anastomosis of bronchus underwent a bilateral lung transplantation in Jan.1998.Multiple processes of dilation and Nd:YAG laser treatment through both fiberoptic and rigid bronchoscope within 13 months were performed. Results we succeeded in remaining the diameter of left anastomosis 10 mm but failed in the right. Then we had to do right pneumonectomy because of repeated pneumonia. Tuberculosis infection was found in the wall of stenosed area.Conclusion Ischemia of bronchus, large dose of corticosteroid and tuberculosis may contribute to the stenosis of this patient. Early treatment of dilation using conscious sedation was critical and the effect of metal hollowed bar like dilator may be better than the balloon ones.