Jennings R W, Lorenz H P, Duncan B W, Bradley S M, Harrison M R, Adzick N S
Department of Surgery, University of California, San Francisco.
J Pediatr Surg. 1992 Oct;27(10):1285-90. doi: 10.1016/0022-3468(92)90275-c.
Babies born with severe pulmonary hypoplasia are unsalvageable despite maximal therapy including extracorporeal membrane oxygenation (ECMO). Using ECMO as a bridge to transplantation, reduced-size lung grafts (pulmonary lobe or segment) could expand the pool of cadaver donors and may allow for HLA-matched living-related transplants. We tested this concept first in the piglet model and developed the technical maneuvers necessary to perform lobar and segmental lung transplants from adult pigs into neonatal piglets. Prior to clinical application, a systematic evaluation of anatomic considerations for reduced-size human lung transplantation was needed. A series of human adult and neonatal cadaver thoracic dissections were performed to determine the adult pulmonary lobe or segment with the proper size, orientation, and vascular and bronchial anatomy for use as a neonatal lung transplant. The adult right middle lobe (RML) is the best candidate for neonatal left lung replacement. The adult RML, once removed, can be rotated 180 degrees around its superior-inferior axis and the vessels and bronchus align well in the left chest of the neonate. The RML may require further reduction to fit into the neonatal left chest. Selective arterial perfusion of the RML showed the anterior segment to be a near-perfect match for fit and anatomy. This technique may eventually permit living-related lung transplantation.
患有严重肺发育不全的新生儿，即便接受包括体外膜肺氧合（ECMO）在内的最大程度治疗也无法挽救。将ECMO作为移植桥梁，缩小尺寸的肺移植物（肺叶或肺段）可以扩大尸体供体库，并可能实现HLA匹配的亲属活体移植。我们首先在仔猪模型中测试了这一概念，并开发了将成年猪的肺叶和肺段移植到新生仔猪体内所需的技术操作。在临床应用之前，需要对缩小尺寸的人类肺移植的解剖学考虑因素进行系统评估。进行了一系列成人和新生儿尸体胸部解剖，以确定适合用作新生儿肺移植的具有合适大小、方向以及血管和支气管解剖结构的成人肺叶或肺段。成人右中叶（RML）是新生儿左肺替代的最佳候选者。成人RML一旦切除，可绕其上下轴旋转180度，其血管和支气管在新生儿左胸内排列良好。RML可能需要进一步缩小以适应新生儿左胸。对RML进行选择性动脉灌注显示，前段在贴合度和解剖结构上几乎完美匹配。这项技术最终可能允许亲属活体肺移植。
