Kawaguchi A, Gandjbakhch I, Pavie A, Bors V, Leger P, Cabrol A, Eugene M, Delcourt A, Cabrol C
Department of Thoracic and Cardiovascular Surgery, Hôpital de la Pitie, Paris, France.
J Thorac Cardiovasc Surg. 1989 Sep;98(3):343-9.
Orthotopic en bloc transplantation of the heart and one lung has been done in two patients with end-stage cardiopulmonary disease and a prior thoracic operation. The first patient had undergone right pulmonary thromboembolectomy with caval ligation 5 years earlier, and the second had had left lower lobectomy for bronchiectasis 15 years before the heart and contralateral lung transplantation. Surgical procedures followed the techniques that had been developed in animals. Transplantation of the unoperated contralateral lung made it possible to avoid dissection in the obliterated pleural space and to minimize bleeding, which simplified the procedure considerably. Dramatic reduction in pulmonary artery pressure and improved respiratory function allowed both patients to be weaned from cardiopulmonary bypass without problems. Although the first patient died of liver and renal failure soon after the operation, an intact cough reflex facilitated recovery in the second patient, who has been discharged with essentially normal respiratory function. This report describes heart and unilateral lung transplantation as a procedure of choice for patients with extensive pleural adhesions that made total cardiopulmonary replacement unfeasible.
已对两名终末期心肺疾病且曾接受过胸部手术的患者进行了心脏和单肺整块原位移植。第一名患者5年前接受了右肺血栓切除术并结扎了腔静脉，第二名患者在心脏和对侧肺移植前15年因支气管扩张接受了左下肺叶切除术。手术程序遵循在动物身上已开发出的技术。未手术的对侧肺移植使得避免在闭塞的胸膜腔内进行解剖并将出血降至最低成为可能，这极大地简化了手术过程。肺动脉压力显著降低以及呼吸功能改善使两名患者都能顺利脱离体外循环。尽管第一名患者术后不久死于肝肾功能衰竭，但完整的咳嗽反射促进了第二名患者的康复，该患者已出院，呼吸功能基本正常。本报告描述了心脏和单侧肺移植是广泛胸膜粘连致使全心肺置换不可行的患者的一种首选手术方法。
