Patterson G A, Todd T R, Cooper J D, Pearson F G, Winton T L, Maurer J
Division of Thoracic Surgery and Pulmonary Medicine, University of Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 1990 Jan;99(1):14-20; discussion 20-1.
We have had success with en bloc double lung transplantation in the management of selected patients with end-stage parenchymal pulmonary disease. Airway complications have been more prevalent in our own experience with double lung transplantation than in reports of combined heart-lung transplantation from other centers. Between November 1986 and March 1989, 16 patients underwent double lung transplantation. Allografts were preserved by topical hypothermic immersion in 12 patients and by pulmonary artery flush with cold crystalloid solution in the most recent four patients. Thirteen patients underwent tracheal anastomosis and the most recent three patients underwent bilateral bronchial anastomoses. Fatal ischemic necrosis of the donor trachea and both main bronchi developed in three patients. Preterminal airway ischemia developed in a patient who had systemic sepsis. Partial anastomotic dehiscence, which went on to form fibrous strictures necessitating endoscopic placement of silicone rubber airway stents, developed in two additional patients. Two other patients had late strictures and required subsequent placement of bifurcation stents. There was no relationship between development of airway complications and gas exchange in the donor lungs, lung ischemic time, early postoperative gas exchange, early postoperative mean pulmonary artery pressure, or frequency of early postoperative rejection. Severe postoperative hypotension occurred in five of eight patients with airway complications and in three of eight patients without airway complications.
我们在对选定的终末期实质性肺部疾病患者进行整体双肺移植治疗方面取得了成功。在我们自己进行双肺移植的经验中，气道并发症比其他中心报道的心肺联合移植更为普遍。1986年11月至1989年3月期间，16例患者接受了双肺移植。12例患者的同种异体移植物通过局部低温浸泡保存，最近4例患者通过肺动脉冷晶体溶液灌注保存。13例患者进行了气管吻合，最近3例患者进行了双侧支气管吻合。3例患者发生了供体气管和双侧主支气管的致命性缺血坏死。1例发生全身性脓毒症的患者出现了终末期气道缺血。另外2例患者出现了部分吻合口裂开，进而形成纤维性狭窄，需要在内镜下放置硅橡胶气道支架。另外2例患者出现晚期狭窄，随后需要放置分叉支架。气道并发症的发生与供体肺的气体交换、肺缺血时间、术后早期气体交换、术后早期平均肺动脉压或术后早期排斥反应的频率无关。8例发生气道并发症的患者中有5例以及8例未发生气道并发症的患者中有3例出现了严重的术后低血压。
