McGahren E D, Teague W G, Flanagan T L, White B J, Barone G W, Johnson A M, Kron I L
Department of Surgery, University of Virginia School of Medicine, Charlottesville 22908.
J Thorac Cardiovasc Surg. 1989 Apr;97(4):587-92.
Bronchiolitis obliterans (irreversible small airway obstruction) is a late complication of heart-lung transplantation. Chronic immune rejection is believed to be the major cause of this complication. Our hypothesis was that denervation might contribute to airway obstruction. To test this hypothesis in the absence of immune rejection, we performed a lobectomy of the upper lobe of the left lung and autologous reimplantation of the lower lobe of the left lung in 13 growing pigs. To serve as age-matched controls, six other pigs had sham left thoracotomy and nine others had a lobectomy of the upper lobe of the left lung alone. Nine to 10 weeks after operation, the animals were anesthetized and the lungs mechanically ventilated. The lobes were then isolated in vivo to measure differential transrespiratory mechanics and volumes. Dynamic compliance was significantly lower in the reimplanted lobe than it was in the contralateral right lung. This was the case after lobectomy of the upper lobe of the left lung or sham thoracotomy. Dynamic resistance was significantly higher in the reimplanted lobe than it was in the contralateral right lung and in the left lung after sham thoracotomy. Measurements of extravascular lung water, dry lobe weight, alveolar cross-sectional area, and volumetric proportions of lung parenchyma and alveolar spaces did not demonstrate abnormal structural growth after reimplantation. We conclude that lobectomy of the upper lobe of the left lung and autologous reimplantation of the left lower lobe leads to adverse changes in flow-dependent measurements of airway patency. Changes in bronchomotor regulation imposed by denervation may contribute to airway obstruction after heart-lung transplantation.
闭塞性细支气管炎（不可逆性小气道阻塞）是心肺移植的晚期并发症。慢性免疫排斥被认为是该并发症的主要原因。我们的假设是去神经支配可能导致气道阻塞。为了在无免疫排斥的情况下验证这一假设，我们对13头生长中的猪进行了左肺上叶肺叶切除术及左肺下叶自体再植入术。作为年龄匹配的对照组，另外6头猪接受了假左侧开胸手术，还有9头仅接受了左肺上叶肺叶切除术。术后9至10周，将动物麻醉并进行机械通气。然后在体内分离肺叶以测量不同的跨呼吸力学和容积。再植入肺叶的动态顺应性显著低于对侧右肺。左肺上叶肺叶切除术后或假开胸术后均是如此。再植入肺叶的动态阻力显著高于对侧右肺及假开胸术后的左肺。血管外肺水、肺叶干重、肺泡横截面积以及肺实质和肺泡腔的容积比例测量结果显示，再植入后未出现异常的结构生长。我们得出结论，左肺上叶肺叶切除术及左肺下叶自体再植入术会导致气道通畅性的流量依赖性测量出现不良变化。去神经支配引起的支气管运动调节变化可能导致心肺移植术后的气道阻塞。
