同种异体肺移植支气管的吻合及气道并发症的防治

目的探讨同种异体肺移植手术过程中供、受体支气管的吻合方法以及气道并发症的防治措施。方法对11例患者行肺移植手术，其中单肺移植6例，双肺移植5例；肺淋巴管平滑肌瘤病3例，弥漫性肺纤维化2例，矽肺2例，支气管扩张症1例，慢性阻塞性肺疾病3例。供、受体支气管的吻合采用套叠缝合法，并以肋间肌、支气管周围组织和心包脂肪组织包盖。结果术后早期吻合口裂开发生率为0；远期发生气道并发症2例，气道并发症发生率为18％。1例术后4月死亡，1例经治疗好转并随访中。结论供、受体支气管的吻合及气道并发症的防治是决定肺移植手术成功与否的关键因素；支气管套叠缝合法避免了早期气道并发症的发生；排异反应和感染是肺移植术后气道并发症发生的主要原因；支气管镜的检查和治疗在肺移植气道并发症的防治中起着重要作用。

Bronchial anastomosis and treatment of airway complication of allogeneic lung transplantation

Objective To discuss the technical methods of bronchial anasmotosis of supplier and receptor,and to explore the treatment of airway complication in allogeneic lung transplantation.Methods 5 bilateral sequential lung transplantations and 6 single lung transplantations were successfully performed.Of 11 cases,there were lymphangioleiomyomatosis(LAM) in 3 cases,diffused pulmonary fibrosis in 2 cases,silicosis in 2 cases,bronchiectasis in 1 case,and chronic obstructive lung disease(COPD) in 3 cases.All the anasmotoses were completed to achieve intussusception and were covered by either local peribronchial tissue,local pericardial fat or intercostal muscle.Results There is no anasmotosis dehiscence.The long-term incidence of airway complication was 18%(2/11),of whom one case died 4 months after transplantation and one case was improved by transplantation.Conclusion The adequate method of anasmotosis and the management of airway complication are the key points to the success of lung transplantation.Telescoping suture of the anasmotosis avoids the early airway complication.Rejection and infection are the main causes of airway complication.Bronchoscopy plays an important role in the prevention and treatment of airway complication.