Sundset A, Tadjkarimi S, Khaghani A, Kvernebo K, Yacoub M H
Department of Thoracic and Cardiovascular Surgery, Harefield Hospital, Middlesex, United Kingdom.
Ann Thorac Surg. 1997 Mar;63(3):790-5. doi: 10.1016/s0003-4975(96)01273-8.
Ischemic airway complications are common after en bloc double-lung transplantation with tracheal anastomosis. The aim of this study was to evaluate the effects of a direct revascularization of the donor bronchial artery with the recipient internal thoracic artery on airway perfusion.
Seven patients undergoing double-lung transplantation with tracheal anastomosis were investigated intraoperatively and postoperatively (12 to 36 hours) with endoscopic laser Doppler flowmetry. Sixteen patients undergoing coronary artery bypass grafting served as a control group.
Two patients who had double-lung transplantation with tracheal anastomosis died of sepsis and multiorgan failure 1 week after transplantation. In the remaining 5 patients healing of the anastomosis was excellent during the observation period of 3 to 52 months. In 5 patients clamping of the attached internal thoracic artery induced a reduction of the laser Doppler flowmetry signal from 10% to 60%. In the 2 patients with the highest graft perfusion level, no clamping effect could be detected. Compared with the control group, perfusion was significantly higher in the transplanted airways intraoperatively, at 71 versus 55 arbitrary perfusion units (p < 0.01). Postoperative transplant airway perfusion values were not significantly different from the intraoperative value. The coefficient of variation of repeated measurements was higher in the transplanted airways, with a coefficient of variation of 0.22 versus 0.17 in the control group (p < 0.01), indicating heterogeneous transplant airway perfusion.
This study has documented that revascularization with the internal thoracic artery supplies the transplanted airway with additional oxygenated blood.
在整块双肺移植并进行气管吻合术后，缺血性气道并发症很常见。本研究的目的是评估供体支气管动脉与受体胸廓内动脉直接血管重建对气道灌注的影响。
对7例行双肺移植并气管吻合术的患者在术中及术后（12至36小时）采用内镜激光多普勒血流仪进行研究。16例行冠状动脉旁路移植术的患者作为对照组。
2例行双肺移植并气管吻合术的患者在移植后1周死于败血症和多器官功能衰竭。在其余5例患者中，吻合口在3至52个月的观察期内愈合良好。在5例患者中，夹闭附着的胸廓内动脉导致激光多普勒血流仪信号从10%降至60%。在2例移植灌注水平最高的患者中，未检测到夹闭效应。与对照组相比，术中移植气道的灌注明显更高，分别为71个任意灌注单位和55个任意灌注单位（p<0.01）。术后移植气道灌注值与术中值无显著差异。移植气道重复测量的变异系数更高，为0.22，而对照组为0.17（p<0.01），表明移植气道灌注不均匀。
本研究证明，胸廓内动脉血管重建为移植气道提供了额外的含氧血液。
