Baldwin J C, Jamieson S W, Oyer P E, Stinson E B, Billingham M E, Shumway N E, Mark J B
J Thorac Cardiovasc Surg. 1985 Jan;89(1):1-7.
Eighteen combined heart and lung transplant operations were performed between March, 1981, and March, 1984. Six of these patients have undergone bronchoscopy, at varying intervals after transplantation. Five of these procedures were done for specific clinical indications; one was done incidentally, during another surgical procedure requiring general anesthesia. All patients had intact, healing tracheal anastomotic suture lines; there were no instances of tracheal stenosis. The distal tracheobronchial tree appeared endoscopically normal in the transplanted lungs, except in areas of known infiltrates. Four of the patients had endobronchial biopsies, and alveolar eosinophilic proteinaceous exudate and submucosal mononuclear infiltrate were consistent features. Two of the later biopsies suggest that squamous metaplasia of the respiratory epithelium may occur with long-term follow-up. Controversy exists as to the optimal technique for tracheal anastomosis, but in the case of the steroid-treated, immunosuppressed transplant patient, continuous anastomosis with polypropylene has yielded satisfactory results.
1981年3月至1984年3月期间共进行了18例心肺联合移植手术。其中6例患者在移植后的不同时间接受了支气管镜检查。其中5例检查是出于特定的临床指征；1例是在另一次需要全身麻醉的外科手术中偶然进行的。所有患者的气管吻合缝线均完整且正在愈合；未出现气管狭窄的情况。除已知有浸润的区域外，移植肺的远端气管支气管树在内镜下看起来正常。4例患者进行了支气管活检，肺泡嗜酸性蛋白渗出物和黏膜下单核细胞浸润是一致的特征。后来的两次活检表明，长期随访可能会出现呼吸道上皮的鳞状化生。关于气管吻合的最佳技术存在争议，但对于接受类固醇治疗、免疫抑制的移植患者，聚丙烯连续吻合已取得了满意的结果。
