Anderson M B, Kriett J M, Harrell J, Smith C, Kapelanski D P, Tarazi R Y, Perricone A, Jamieson S W
Department of Surgery, University of California at San Diego 92103, USA.
J Heart Lung Transplant. 1995 Nov-Dec;14(6 Pt 1):1090-4.
Many techniques have been described to optimize the construction of the bronchial anastomosis in lung transplantation. Over the past 60 months we have performed 86 bronchial anastomoses in 70 patients receiving single lung or bilateral single lung transplants.
No anastomosis was wrapped and no attempt was made at revascularization of bronchial arteries. A continuous nonabsorbable suturing technique was used in all cases. Standard triple-drug immunotherapy with cyclosporine, azathioprine, and prednisone (starting at day 7) was used for each patient.
There were no anastomotic leaks, and seven stenoses were identified in five patients (7%). All complications were managed conservatively with stenting, and there were no related deaths. Mean time to stent placement was 109 days. One patient had bilateral stents placed prophylactically during an episode of severe infection for questionable anastomotic viability but without evidence of airway necrosis or obstruction. This patient died of infection at 16 days. Another patient died with stents in place at 71 days. In the four remaining patients, all stents have been removed after a mean of 310 days. These patients were followed up with serial bronchoscopy and were without evidence of recurrent obstruction at 2, 34, 35, and 36 months. Six of seven stenoses occurred in patients with cystic fibrosis. In each patient where stenosis developed the anastomosis was telescoped. Since abandoning the telescoping technique in the remaining 50 anastomoses (14 in patients with cystic fibrosis), no dehiscence or stenosis was encountered.
These data suggest that elaborate techniques aimed at construction of the bronchial anastomosis are not necessary. Moreover, attempts at telescoping may be detrimental. Patients with cystic fibrosis may be a population at higher risk for anastomotic complications. Airway complications can be managed conservatively with good results and little risk to the patient.
已有多种技术用于优化肺移植中支气管吻合术的构建。在过去60个月里，我们对70例接受单肺或双侧单肺移植的患者进行了86次支气管吻合术。
所有吻合口均未包裹，也未尝试对支气管动脉进行血管重建。所有病例均采用连续不可吸收缝合技术。每位患者均接受标准的三联药物免疫治疗，即使用环孢素、硫唑嘌呤和泼尼松（从第7天开始）。
未发生吻合口漏，5例患者（7%）出现7处狭窄。所有并发症均通过支架置入进行保守处理，无相关死亡病例。支架置入的平均时间为109天。1例患者在严重感染期间因可疑的吻合口存活能力预防性置入双侧支架，但无气道坏死或阻塞的证据。该患者在16天时死于感染。另1例患者在支架置入后71天死亡。其余4例患者在平均310天后均已取出支架。这些患者通过系列支气管镜检查进行随访，在2、34、35和36个月时均无复发性阻塞的证据。7处狭窄中有6处发生在囊性纤维化患者中。在每例发生狭窄的患者中，吻合口均呈套叠状。自从在其余50次吻合术（14例囊性纤维化患者）中放弃套叠技术后，未再出现裂开或狭窄。
这些数据表明，构建支气管吻合术无需复杂技术。此外，尝试套叠术可能有害。囊性纤维化患者可能是吻合口并发症风险较高的人群。气道并发症可通过保守处理取得良好效果，且对患者风险较小。
