微创再次肺移植的技术与结果。

Technique and Outcomes of Less Invasive Lung Retransplantation.

机构信息

Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.

German Centre for Lung Research, BREATH Site, Hannover, Germany.

出版信息

Transplantation. 2018 Mar;102(3):530-537. doi: 10.1097/TP.0000000000001905.

DOI:10.1097/TP.0000000000001905

PMID:28787308

Abstract

BACKGROUND

Lung retransplantation is a demanding procedure with outcomes lagging primary transplantation. We implemented less invasive surgical techniques aiming at improving early outcomes. Here, we wish to describe these techniques and analyze the clinical outcomes.

METHODS

Since April 2010, a protocol of less invasive techniques was applied to all lung retransplantations. This protocol comprises bilateral lung retransplantation via sternum-sparing anterolateral thoracotomies, off-pump surgery, and empiric administration of 2 g fibrinogen and 2 platelet concentrates. Patient charts were retrospectively reviewed starting in April 2010 until May 2016 for this study and compared with a cohort of patients undergoing lung retransplantation between January 2005 and March 2010.

RESULTS

From April 2010 through March 2016, 774 total lung transplantations were performed at our center, 49 were retransplantations. In the era January 2005 to March 2010, a total of 480 lung transplantations were performed, 38 of those being retransplantations. Mean operation time in the era April 2010 to May 2016 was significantly longer as compared with the era January 2005 to March 2010, median time until extubation was significantly shorter in the era April 2010 to May 2016 (1 [1-2] days vs 11.5 [1-24] days; P = 0.0009). Similarly, median intensive care unit stay time was shorter in the era April 2010 to May 2016 (4 [2-5.5] days vs 12.5 [3-30.5] days; P = 0.003). Patient survival was significantly better in the era starting in April 2010 at 30 days (98% vs 76.3%, P = 0.002) as well as at 1 year (80.6% vs 63.2%; P = 0.01).

CONCLUSIONS

Less invasive retransplantation of the lung via sternum-sparing anterolateral thoracotomies and off-pump is a safe procedure with low associated morbidity and favorable midterm survival.

摘要

背景

肺再移植是一项要求很高的手术，其结果落后于初次移植。我们采用了微创外科技术，旨在改善早期结果。在此，我们希望描述这些技术并分析临床结果。

方法

自 2010 年 4 月以来，一项微创技术方案已应用于所有肺再移植。该方案包括通过胸骨保留前外侧开胸术进行双侧肺再移植、非体外循环手术以及经验性给予 2 克纤维蛋白原和 2 个血小板浓缩物。回顾性分析了 2010 年 4 月至 2016 年 5 月期间进行的这项研究的患者病历，并与 2005 年 1 月至 2010 年 3 月期间进行肺再移植的患者队列进行了比较。

结果

自 2010 年 4 月至 2016 年 3 月，我院共进行了 774 例全肺移植，其中 49 例为再移植。在 2005 年 1 月至 2010 年 3 月期间，共进行了 480 例肺移植，其中 38 例为再移植。2010 年 4 月至 2016 年 5 月期间的手术时间明显长于 2005 年 1 月至 2010 年 3 月期间，2010 年 4 月至 2016 年 5 月期间的拔管时间中位数明显短于 2005 年 1 月至 2010 年 3 月期间（1[1-2]天 vs 11.5[1-24]天；P=0.0009）。同样，2010 年 4 月至 2016 年 5 月期间的重症监护病房住院时间中位数也较短（4[2-5.5]天 vs 12.5[3-30.5]天；P=0.003）。2010 年 4 月开始的时期，患者在 30 天时的生存率（98% vs 76.3%，P=0.002）和 1 年时的生存率（80.6% vs 63.2%；P=0.01）均显著提高。