1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece.
Ann Transl Med. 2015 Aug;3(13):178. doi: 10.3978/j.issn.2305-5839.2015.08.03.
The parenchyma-sparing resection is most often performed in patients with impaired preoperative lung or cardiovascular function who would not be able to tolerate a pneumonectomy.
Our experience on the ex situ reimplantation procedure and the outcome of patients with lung malignancies, who underwent upper or upper-middle lobectomy, with reimplantation of the lower lobe was reported.
We present 9 patients mean age 62.6+16.2 years (7 males/2 females) underwent ex situ reimplantation due to extensive lung tumor of upper lobes. The surgical technique precludes IV heparinization and then radical pneumonectomy. The entire lung was immersed in Ringer's solution (temperature 4 degrees centigrade) and bench surgery was performed. The involved upper (or upper-middle) lobes with involved lymph nodes were resected, thus leaving the healthy lower lobe of the lung. Pneumoplegia solution, named "Papworth pneumoplegia", was administered (1,473 mL) through catheterization of the pulmonary artery and vein stumps (ante grade and retrograde) along with 250 mL of prostaglandin E1. Re-implantation of the lower lobe was performed (I) on the right side, implantation involved the anastomosis of lower pulmonary vein in the site of the cuff of left atrium, followed by suturing the stump of the intermedius pulmonary artery to the right main pulmonary artery and finally the bronchial stumps-intermedius bronchus to the right main bronchus; (II) on the left side the pulmonary vein was anastomosed first, followed by the bronchial stumps and finally by the pulmonary artery. The graft ischemia time was 70.2+8.4 minutes ranged between 55 and 80 minutes.
Re-implantation or auto-transplantation should be considered as a safe option for the appropriate patient with lung cancer. The ex situ separation of the cancerous lobes is technically feasible and allows extensive pulmonary resection while minimizing the loss of pulmonary reserve. Based on our work, the major factors that play a role for the survival of initially resected and then re-implanted lung graft, are: (I) the ischemia time of the re-implanted lobe; (II) the proper use of pneumoplegia solutions, along with prostaglandin E1 and heparin; (III) the occurrence of pulmonary vein thrombosis; and (IV) the bronchial anastomosis.
对于术前肺或心血管功能受损、无法耐受全肺切除术的患者，通常采用保留肺实质的切除术。
我们报告了在体外再植入术方面的经验，以及接受上叶或中上叶肺切除术并进行下叶再植入术的肺癌患者的结果。
我们介绍了 9 名患者，平均年龄 62.6+16.2 岁（7 名男性/2 名女性），由于上叶广泛的肺部肿瘤而接受体外再植入术。该手术技术避免了 IV 肝素化和根治性全肺切除术。整个肺被浸入林格氏液（温度 4 摄氏度）中，并进行了台面上的手术。切除受累的上（或中上）叶及受累的淋巴结，从而留下健康的肺下叶。通过肺动脉和静脉残端（前向和逆行）的导管插入术给予“Papworth 肺停搏液”（1473ml），同时给予 250ml 前列腺素 E1。再植入下叶（I）在右侧，将下肺静脉吻合于左心房袖口处，然后将中间肺动脉残端缝合至右主肺动脉，最后将支气管残端-中间支气管吻合至右主支气管；（II）在左侧，首先吻合肺静脉，然后吻合支气管，最后吻合肺动脉。移植缺血时间为 70.2+8.4 分钟，范围为 55 至 80 分钟。
对于适当的肺癌患者，再植入或自体移植应被视为一种安全的选择。癌性肺叶的体外分离在技术上是可行的，允许广泛的肺切除术，同时最大限度地减少肺储备的损失。根据我们的工作，最初切除然后再植入的肺移植物存活的主要因素是：（I）再植入肺叶的缺血时间；（II）适当使用肺停搏液，同时使用前列腺素 E1 和肝素；（III）肺静脉血栓形成的发生；以及（IV）支气管吻合术。
