Chhajed P N, Malouf M A, Tamm M, Spratt P, Glanville A R
Heart Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
Chest. 2001 Dec;120(6):1894-9. doi: 10.1378/chest.120.6.1894.
To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation.
Retrospective study.
Heart-lung transplant unit of a university hospital.
From November 1986 to January 2000, interventional bronchoscopy was performed in 41 of 312 lung transplant recipients (13.1%) for tracheobronchial stenosis, bronchomalacia, granuloma formation, and dehiscence.
Dilatation, stent placement, laser or forceps excision.
Mean (+/- SE) improvement in FEV(1) in 26 patients undergoing dilatation for a stenotic or a combined lesion was 93 +/- 334 mL or 8 +/- 21%. In seven of these patients not proceeding to stent placement, mean improvement in FEV(1) was 361 +/- 179 mL or 21 +/- 9%. Patients needing stent placement after dilatation had a mean change in FEV(1) after dilatation of - 5 +/- 325 mL or 3 +/- 23%, and an improvement of 625 +/- 480 mL or 52 +/- 43% after stent insertion. Mean improvement in FEV(1) for patients treated with stent insertion for bronchomalacia was 673 +/- 30 mL or 81 +/- 24%. Complications of airway stents were migration (27%), mucous plugging (27%), granuloma formation (36%), stent fracture (3%), and formation of a false passage (6%). Mortality associated with interventional bronchoscopy was 2.4% (1 of 41 patients). For patients with airway complications successfully undergoing interventional bronchoscopy, the overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and 32%, respectively, vs 87%, 69%, and 56% for those without airway complications (p < 0.05).
Only a small number of patients with airway stenosis after lung transplantation will respond to bronchial dilatation alone. Patients with airway complications after lung transplantation have a higher mortality than patients without airway complications.
评估用于治疗肺移植术后气道并发症的不同介入性支气管镜技术的疗效及并发症。
回顾性研究。
一所大学医院的心肺移植科。
1986年11月至2000年1月期间，312例肺移植受者中有41例（13.1%）因气管支气管狭窄、支气管软化、肉芽肿形成及裂开接受了介入性支气管镜检查。
扩张、支架置入、激光或钳夹切除。
26例因狭窄或合并病变接受扩张治疗的患者，第1秒用力呼气容积（FEV₁）平均（±标准误）改善93±334ml或8±21%。其中7例未置入支架的患者，FEV₁平均改善361±179ml或21±9%。扩张后需要置入支架的患者，扩张后FEV₁平均变化为-5±325ml或3±23%，置入支架后改善625±480ml或52±43%。因支气管软化接受支架置入治疗的患者，FEV₁平均改善673±30ml或81±24%。气道支架的并发症包括移位（27%）、黏液堵塞（27%）、肉芽肿形成（36%）、支架断裂（3%）及假道形成（6%）。介入性支气管镜检查相关死亡率为2.4%（41例患者中的1例）。成功接受介入性支气管镜检查的气道并发症患者，总体1年、3年及5年生存率分别为79%、45%和32%，而无气道并发症患者分别为87%、69%和56%（p<0.05）。
肺移植术后仅有少数气道狭窄患者单独支气管扩张治疗有效。肺移植术后有气道并发症的患者死亡率高于无气道并发症的患者。
