Higgins R, McNeil K, Dennis C, Parry A, Large S, Nashef S A, Wells F C, Flower C, Wallwork J
Transplant Unit, Papworth Hospital, Cambridge, United Kingdom.
J Heart Lung Transplant. 1994 Sep-Oct;13(5):774-8.
Success in lung transplantation has been hindered by airway complications, usually as a result of anastomotic ischemia and stenosis. We report our experience with expanding metal stents in managing airway stenoses after lung transplantation. From April 1984 through November 1993, 46 single lung, 5 double lung, and 154 heart-lung transplantations were performed at Papworth Hospital. All patients received immunosuppression with azathioprine, cyclosporine, methylprednisolone, and induction antithymocyte globulin. Fourteen patients (nine single lung, two double lung, and three heart-lung) had an airway stenosis requiring a stent. The most common features were shortness of breath, wheezing or stridor, and a fall in pulmonary function tests (11 patients). Three patients had pneumonia. Airway stenosis was diagnosed on bronchoscopy an average of 61 days after transplantation (range 3 to 245 days). Stent placement occurred an average of 18 days after the diagnosis (range 2 to 84 days). One heart-lung transplant recipient received a silicone rubber stent. All other patients received expanding metal stents. Six patients required multiple stent placements. After stent placement the average increase in the forced expiratory volume in 1 second was 117%. Infection complicated the stenoses in 12 patients. Pseudomonas aeruginosa and Aspergillus fumigatus were the most common pathogens, each occurring in six cases. Multiple pathogens were isolated in seven cases. Three patients died as a direct consequence of their airway problems. Two died of pneumonia despite stenting, and a third died of acute occlusion of the silicone rubber stent. Expanding metal stents are an effective treatment of airway stenoses in lung transplant recipients. Patients with suspected airway problems should be referred for early bronchoscopy with the potential for stent placement.
肺移植的成功一直受到气道并发症的阻碍，这些并发症通常是由吻合口缺血和狭窄引起的。我们报告了我们在使用可扩张金属支架治疗肺移植术后气道狭窄方面的经验。1984年4月至1993年11月，帕普沃思医院共进行了46例单肺移植、5例双肺移植和154例心肺移植。所有患者均接受硫唑嘌呤、环孢素、甲泼尼龙和诱导性抗胸腺细胞球蛋白的免疫抑制治疗。14例患者（9例单肺移植、2例双肺移植和3例心肺移植）出现气道狭窄需要置入支架。最常见的症状是呼吸急促、喘息或喘鸣，以及肺功能测试结果下降（11例患者）。3例患者发生肺炎。气道狭窄平均在移植后61天通过支气管镜检查确诊（范围为3至245天）。支架置入平均在诊断后18天进行（范围为2至84天）。1例心肺移植受者接受了硅橡胶支架。所有其他患者均接受可扩张金属支架。6例患者需要多次置入支架。置入支架后，一秒用力呼气量平均增加了117%。12例患者的狭窄出现感染并发症。铜绿假单胞菌和烟曲霉是最常见的病原体，各出现6例。7例患者分离出多种病原体。3例患者因气道问题直接死亡。2例患者尽管置入了支架仍死于肺炎，第3例死于硅橡胶支架急性阻塞。可扩张金属支架是治疗肺移植受者气道狭窄的有效方法。怀疑有气道问题的患者应尽早转诊进行支气管镜检查，并有可能置入支架。
