Schmid R A, Boehler A, Speich R, Frey H R, Russi E W, Weder W
Dept of Surgery, Pulmonary Division, University Hospital, Zürich, Switzerland.
Eur Respir J. 1997 Dec;10(12):2872-5. doi: 10.1183/09031936.97.10122872.
The frequency of bronchial anastomotic complications following lung transplantation has decreased in recent years, but continues to be a potential cause of morbidity and mortality. We have, therefore, reviewed the results of 67 consecutive bronchial anastomoses at risk in 43 patients surviving more than 7 days following lung transplantation. The bronchial anastomoses were performed using a standardized technique, without direct or indirect revascularization. Regular triple immunosuppressive therapy was given, including prednisone (0.5 mg x kg(-1) daily) starting on the day of surgery. Bronchial healing was graded using the Couraud classification. The median follow-up time was 14 months (range 1-45 months). No major airway complications occurred. On 236 serial bronchoscopic examinations, no anastomotic stenoses were observed. One anastomosis showed limited focal necrosis (2 mm) (Couraud 3a), and two anastomoses had partial primary mucosal healing without necrosis (Couraud 2a). In all other anastomoses, primary mucosal healing (Couraud 1) was observed. Carefully performed bronchial anastomosis according to the technique described enables reliable bronchial healing and yields a low complication rate. Additional measures, such as direct revascularization, forced telescoping, omentum wrap and interruption of steroid therapy, are not necessary.
近年来，肺移植术后支气管吻合口并发症的发生率有所下降，但仍是发病和死亡的潜在原因。因此，我们回顾了43例肺移植术后存活超过7天的患者连续67例存在风险的支气管吻合术的结果。支气管吻合术采用标准化技术进行，未进行直接或间接血管重建。术后常规给予三联免疫抑制治疗，包括从手术当天开始使用泼尼松（每日0.5mg/kg）。采用库劳德分类法对支气管愈合情况进行分级。中位随访时间为14个月（范围1 - 45个月）。未发生重大气道并发症。在236次连续支气管镜检查中，未观察到吻合口狭窄。1例吻合口出现局限性灶性坏死（2mm）（库劳德3a级），2例吻合口出现部分原发性黏膜愈合且无坏死（库劳德2a级）。在所有其他吻合口中，均观察到原发性黏膜愈合（库劳德1级）。按照所述技术仔细进行支气管吻合术能够实现可靠的支气管愈合，且并发症发生率较低。无需采取额外措施，如直接血管重建、强制套叠、网膜包裹和中断类固醇治疗等。
