LoCicero J, Shih S R, Zhao F R, Frederiksen J W, Hartz R S, Michaelis L L
Department of Surgery, Northwestern University Medical School, Chicago, Ill.
J Thorac Cardiovasc Surg. 1989 Apr;97(4):582-6.
Single lung transplantation now is a therapeutic option for some patients with end-stage lung disease. Cyclosporine immunosuppression and refinements in bronchial anastomosis have been responsible for recent successes. Since 1953, the usual pulmonary venous anastomosis, both in experimental animals and in humans, has been an atrium-to-atrium connection. This technique may limit the availability of usable donor lungs, since the donor heart, along with the atrium, is usually harvested for another recipient. Although techniques can be developed to allow both transplant teams to harvest atrial tissue, this study was undertaken to determine if, in fact, anastomosis with donor left atrium is necessary. Twenty-four dogs were anesthetized and a left thoracotomy performed. After heparinization (3 mg/kg), the pulmonary artery and left atrium were occluded. One of four different pulmonary venous anastomoses was performed at 3.5x magnification: superior pulmonary vein end to end (group I), inferior pulmonary vein end to end (group II), superior pulmonary vein implantation into left atrium (group III), and left atrium-to-left atrium anastomosis as control (group IV). Everting mattress sutures of 7-0 polypropylene were used in groups I, II, and III and 6-0 in group IV. Average crossclamp time for group I, group II, and group IV was 20 minutes. The average crossclamp time for group III was 10 minutes. All anastomoses were patent at the time of 1-week reevaluation. Gross and microscopic examination demonstrated establishment of an intimal lining; organized nonocclusive thrombus was present in only one anastomosis. We conclude that atrium-to-atrium anastomosis is not necessary for a successful single lung transplantation, and that transplantation of a single lobe is feasible. The best alternative is implantation of the pulmonary vein into the left atrium, which will easily allow use of the heart and both lungs from a single donor to different recipients. We have used this anastomosis in one patient without difficulty.
单肺移植目前是一些终末期肺病患者的一种治疗选择。环孢素免疫抑制和支气管吻合技术的改进促成了近期的成功。自1953年以来，在实验动物和人类中，常见的肺静脉吻合方式一直是心房对心房连接。这种技术可能会限制可用供体肺的获取，因为供体心脏通常会连同心房一起被摘取用于另一位受者。尽管可以开发技术让两个移植团队都能获取心房组织，但开展这项研究是为了确定与供体左心房吻合实际上是否必要。24只狗被麻醉并进行左胸切开术。肝素化（3毫克/千克）后，肺动脉和左心房被阻断。在3.5倍放大倍数下进行四种不同的肺静脉吻合之一：肺上静脉端端吻合（第一组）、肺下静脉端端吻合（第二组）、肺上静脉植入左心房（第三组），以及作为对照的左心房对左心房吻合（第四组）。第一组、第二组和第三组使用7-0聚丙烯外翻褥式缝线，第四组使用6-0缝线。第一组、第二组和第四组的平均阻断时间为20分钟。第三组的平均阻断时间为10分钟。在1周复查时，所有吻合口均通畅。大体和显微镜检查显示内膜衬里已形成；仅一个吻合口中存在有组织的非阻塞性血栓。我们得出结论，对于成功的单肺移植，心房对心房吻合并非必要，单叶移植是可行的。最佳替代方法是将肺静脉植入左心房，这将便于把来自单个供体的心脏和双肺用于不同的受者。我们已毫无困难地在一名患者中使用了这种吻合方法。
