肺移植术后气道狭窄的诊断和治疗

目的 探讨使用支气管镜诊断和治疗肺移植术后支气管吻合口狭窄的效果。方法 回顾性分析2002年9月至2005年8月间24例肺移植患者的临床资料。所有患者均行支气管镜检查，发现气道狭窄后即通过支气管镜进行治疗。结果 24例受者（共28个吻合口）中，有2例发生吻合口（左侧1例，双侧1例）狭窄。第1次采用活检钳取出及微波凝固治疗，患者分别于治疗后的第73及26d再次发生气道并发症。第2次治疗采用经支气管镜高频电刀切除及凝固局部肉芽组织，彻底清除坏死组织，治疗效果较理想，随访至今无复发。结论 术后常规采用支气管镜检查可及时发现气道并发症。经支气管镜采用高频电刀切除、凝固肉芽组织及气道清理能有效的治疗肺移植术后气道狭窄。

Interventional bronchoscopy for the management of airway complications following lung transplantation

Objective To assess the efficacy of interventional bronchoscopic techniques used to treat stenosis of bronchial anastomosis after lung transplantation.Methods A retrospective study of 24 cases who underwent lung transplantation from September 2003 to August 2005 in our Unit was done. All recipients were subjected to surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Endobronchial electrocauterization with microwave therapy apparatus and endobronchial electrocoagulation with high-frequency electrotome were performed for the management of bronchial stenosis or granuloma formation.Results There were 2 of 24 recipients (2/24,8.3 %) with stenosis of bronchial anastomosis. Airway stenosis appeared in 3 of 28 anastomoses (3/28,10.7 %): 2 on the left and 1 on the right. These patients with airway stenosis responded to interventional bronchoscopy,and their respiratory function was improved significantly.Conclusions Despite the improvements in surgical technique and immunosuppression strategies,a small number of patients still had airway complications after lung transplantation. Interventional bronchoscopic techniques,i.e. endobronchial electrocauterization with microwave therapy apparatus and endobronchial electrocoagulation with high-frequency electrotome will be effective in the treatment of airway complications after lung transplantation and with good response in respiratory function.