Daly R C, Tadjkarimi S, Khaghani A, Banner N R, Yacoub M H
Department of Thoracic and Cardiovascular Surgery, Harefield Hospital, Middlesex, United Kingdom.
Ann Thorac Surg. 1993 Oct;56(4):885-92. doi: 10.1016/0003-4975(93)90350-q.
Double-lung transplantation with tracheal anastomosis has previously resulted in unacceptable ischemic complications of airway healing. Three patients underwent double-lung transplantation at our institution in 1986 and 1987, and 2 of these required later retransplantation because of airway complications. Recently, we began to perform direct revascularization of the bronchial arteries at their origin on the donor descending thoracic aorta, using recipient internal thoracic artery. Eight patients (2 male and 6 female patients; ages, 10-51 years) underwent nine double-lung transplantations with revascularization. The preoperative diagnoses in these patients were cystic fibrosis (2 patients), atrial septal defect and Eisenmenger's syndrome (1 patient), lymphagioleiomyomatosis (1 patient), bronchiectasis (1 patient), alpha 1-antitrypsin deficiency (1 patient), and primary pulmonary hypertension (2 patients); 1 underwent retransplantation because of pulmonary emboli. There have been no significant airway complications in any patient. Two patients died early postoperatively, 1 of early pulmonary dysfunction (at 1 day postoperatively) and 1 of subarachnoid hemorrhage (at 16 days postoperatively; tracheal healing was excellent in this patient). Follow-up in the remaining 6 patients ranged from 5 to 9 months. Internal thoracic artery angiography was performed on seven grafts, which documented patency of the internal thoracic artery in all seven and bronchial artery perfusion in six. Bronchoscopic examinations have demonstrated excellent airway healing in all six of these grafts, with no dehiscence, granulation, or narrowing of the trachea or distal bronchi. Ulceration of the tracheal anastomosis developed anteriorly in the remaining patient, which has resolved. We conclude that double-lung transplantation is an acceptable therapeutic approach when combined with bronchial artery revascularization, and early airway healing has been excellent.(ABSTRACT TRUNCATED AT 250 WORDS)
双肺移植合并气管吻合术此前曾导致气道愈合出现难以接受的缺血性并发症。1986年和1987年，我们机构有3例患者接受了双肺移植，其中2例因气道并发症后来需要再次移植。最近，我们开始在供体降主动脉的支气管动脉起始处使用受体胸廓内动脉进行直接血管重建。8例患者（2例男性和6例女性患者；年龄10 - 51岁）接受了9次双肺移植并进行了血管重建。这些患者的术前诊断为囊性纤维化（2例）、房间隔缺损合并艾森曼格综合征（1例）、淋巴管平滑肌瘤病（1例）、支气管扩张（1例）、α1 -抗胰蛋白酶缺乏症（1例）和原发性肺动脉高压（2例）；1例因肺栓塞接受了再次移植。所有患者均未出现明显的气道并发症。2例患者术后早期死亡，1例死于早期肺功能障碍（术后1天），1例死于蛛网膜下腔出血（术后16天；该患者气管愈合良好）。其余6例患者的随访时间为5至9个月。对7例移植血管进行了胸廓内动脉血管造影，结果显示所有7例胸廓内动脉均通畅，6例有支气管动脉灌注。支气管镜检查显示，所有这6例移植血管的气道愈合良好，气管或远端支气管均无裂开、肉芽组织或狭窄。其余1例患者气管吻合口前方出现溃疡，现已愈合。我们得出结论，双肺移植与支气管动脉血管重建相结合是一种可接受的治疗方法，且早期气道愈合良好。（摘要截短至250字）
