Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
J Thorac Cardiovasc Surg. 2018 Jul;156(1):451-460. doi: 10.1016/j.jtcvs.2017.10.150. Epub 2018 Apr 7.
The validity of lobar lung transplantation (LT) has been established in both living-donor lobar lung transplantation (LDLLT) and cadaveric-donor lung transplantation (CLT). However, bronchial stump management in lobar LT has not been precisely documented. Thus, we retrospectively analyzed our strategies for bronchial stump management in lobar LT.
Between June 2008 and August 2016, 145 LTs (72 LDLLTs and 73 CLTs) were performed at our institution. Bronchial stumps were left in 14 LDLLTs. Eight patients underwent bilateral CLTs with downsizing lobectomy. We avoided leaving donor bronchial stumps by lobar-to-lobar bronchial anastomosis, and left recipient bronchial stumps if necessary. We retrospectively reviewed the bronchial stump management methods and outcomes in these 22 patients.
Among the 14 LDLLTs, right-to-left inverted lobar LT and right single-lobe LT with left pneumonectomy were performed in 12 and 2 patients, respectively. Among the 8 CLTs, 11 lobectomies were performed because of oversized grafts and/or localized pneumonia. Twenty-three lobar-to-lobar bronchial anastomoses were performed, and there were 21 recipient bronchial stumps in total. Three bronchial stumps were left in the donor graft, the middle bronchus in all cases. No complications related to lobar-to-lobar bronchial anastomoses were observed. All bronchial stumps healed well without developing a bronchopleural fistula. The 3-year overall survival rate was 88.1% (95% confidence interval, 58.8%-97.0%).
We successfully avoided leaving bronchial stumps in the donor graft, except in the middle bronchus, by performing lobar-to-lobar bronchial anastomoses in lobar LTs. Excellent healing of lobar-to-lobar bronchial anastomoses and bronchial stumps was observed.
活体供肺叶移植（LDLLT）和尸体供肺叶移植（CLT）均已证实肺叶移植的有效性。然而，肺叶移植中支气管残端的处理尚未得到准确记录。因此，我们回顾性分析了肺叶移植中支气管残端的处理策略。
2008 年 6 月至 2016 年 8 月，本中心共完成 145 例肺叶移植（72 例 LDLLT 和 73 例 CLT）。14 例 LDLLT 中保留了支气管残端。8 例患者行双侧 CLT 并进行肺段切除术。我们通过叶对叶支气管吻合术避免保留供体支气管残端，并在必要时保留受体支气管残端。我们回顾性分析了这 22 例患者的支气管残端处理方法和结果。
14 例 LDLLT 中，12 例为右向左倒置叶移植，2 例为右单叶加左全肺切除术。8 例 CLT 中，因供体肺过大和/或局限性肺炎而行 11 例肺段切除术。共行 23 例叶对叶支气管吻合术，总共有 21 个受体支气管残端。3 个供体支气管残端留在供体肺中，均为中间支气管。未观察到与叶对叶支气管吻合术相关的并发症。所有支气管残端愈合良好，未发生支气管胸膜瘘。3 年总生存率为 88.1%（95%置信区间，58.8%-97.0%）。
我们通过行叶对叶支气管吻合术，成功避免了除中间支气管以外的供体肺叶中支气管残端的遗留。叶对叶支气管吻合术和支气管残端愈合良好。
