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双侧尸体肺移植后左主支气管吻合口气道裂开的成功保守治疗

Successful conservative management of an anastomotic airway dehiscence at the left main bronchus following bilateral cadaveric lung transplantation.

作者信息

Miyata Ryo, Chen-Yoshikawa Toyofumi F, Hamaji Masatsugu, Gochi Fumiaki, Motoyama Hideki, Menju Toshi, Aoyama Akihiro, Sato Toshihiko, Sonobe Makoto, Date Hiroshi

机构信息

Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.

出版信息

Gen Thorac Cardiovasc Surg. 2018 Jun;66(6):368-371. doi: 10.1007/s11748-017-0826-5. Epub 2017 Sep 2.

Abstract

There is a dearth of data on management of anastomotic airway dehiscence following lung transplantation. Herein we report a case of successful conservative management of an anastomotic airway dehiscence after cadaveric donor lung transplantation. A 41-year-old woman with primary ciliary dyskinesia underwent cadaveric bilateral lung transplantation without cardiopulmonary bypass. On the postoperative day 25, left pneumothorax developed and bronchoscopy demonstrated a localized anastomotic dehiscence at the left main bronchus. The dehiscence was managed with 2 weeks of pleural drainage and was completely covered with regenerated bronchial epithelium at 4 months after transplantation. There is no finding suggestive of significant stenosis at 4 years of follow-up. Our case suggested asymptomatic and localized anastomotic dehiscence does not always require endobronchial stent placement or re-operation. Multiple factors that may contribute to the successful conservative management were discussed in this article.

摘要

关于肺移植后吻合口气道裂开的处理,目前缺乏相关数据。在此,我们报告一例尸体供肺移植后吻合口气道裂开成功保守治疗的病例。一名41岁患有原发性纤毛运动障碍的女性在非体外循环下接受了尸体双侧肺移植。术后第25天,出现左侧气胸,支气管镜检查显示左主支气管存在局限性吻合口裂开。通过2周的胸腔引流对裂开进行处理,移植后4个月时裂开处完全被再生的支气管上皮覆盖。随访4年未发现明显狭窄。我们的病例表明,无症状的局限性吻合口裂开并非总是需要放置支气管内支架或再次手术。本文讨论了可能促成成功保守治疗的多种因素。

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