Greco R, Benito J, Cordovilla G, Sanz E, Gonzalez M, De Miguel E, Tovar J, Galliani C
Pediatric Surgical Department, Hospital Infantil La Paz, Madrid, Spain.
Eur J Pediatr Surg. 1998 Oct;8(5):268-73. doi: 10.1055/s-2008-1071212.
Lung donor shortage is a critical factor limiting the expansion of pediatric lung transplantation programs. This report details the surgical technical feasibility of a training model of lobar lung transplantation as well as the perioperative monitoring to evaluate the appropriate pulmonary graft function.
Ten hybrid Large-White pigs underwent left lower lobe lung allotransplantation; Donors weighed 15 to 20 kg and recipients 5 to 7 kg. The first five animals were used to learn the surgical anatomy and to establish the surgical technique and instrumentation's model (Group A). One hour after transplantation the right lung was excluded. Lung function and hemodynamic data were collected sequentially in the following five animals (Group B).
The left inferior pulmonary lobe was found to be the most suitable allograft for transplantation. Usually, bronchial size discrepancy allowed telescoping of the airway anastomosis. Left atrial clamping was well tolerated during the pulmonary vein anastomoses. Preoperative antiaggregation and postoperatively heparinization achieved with ACT values over 200 seconds, prevented left atrial thrombosis. After right lung exclusion, hemodynamic changes consisted of a sustained increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics were also modified, with a gradual rise in airway resistance and a fall in compliance.
The neonatal pig tolerates left lobar pulmonary transplantation satisfactorily. Although it is a useful and promising surgical learning model, questions remain regarding the applicability of this experience to clinical pediatric lung transplantation.
肺供体短缺是限制小儿肺移植项目扩展的关键因素。本报告详细介绍了肺叶移植训练模型的手术技术可行性以及评估合适肺移植功能的围手术期监测。
十只杂种大白猪接受了左下叶肺同种异体移植；供体体重15至20千克，受体体重5至7千克。前五只动物用于学习手术解剖结构并建立手术技术和器械模型（A组）。移植后一小时，切除右肺。在接下来的五只动物（B组）中依次收集肺功能和血流动力学数据。
发现左下肺叶是最适合移植的同种异体移植物。通常，支气管大小差异允许气道吻合采用套入式。在肺静脉吻合期间，左心房夹闭耐受性良好。术前抗聚集和术后肝素化使活化凝血时间值超过200秒，预防了左心房血栓形成。切除右肺后，血流动力学变化包括肺血管阻力持续增加和心输出量减少。肺力学也发生了改变，气道阻力逐渐升高，顺应性下降。
新生猪对左肺叶移植耐受性良好。虽然它是一种有用且有前景的手术学习模型，但关于这一经验在临床小儿肺移植中的适用性仍存在问题。
