儿童肺移植12例经验分析

目的 总结12例儿童肺移植的临床经验.方法 回顾性分析南京医科大学附属无锡市人民医院2007年12月—2020年8月实施的12例儿童肺移植的资料,重点对适应证、术后并发症及生存率进行分析.结果 12例患儿行肺移植,其中男性5例,女性7例.患儿行肺移植时年龄为2～17岁(年龄中位数为13.5岁),小于12岁5例,占比41...     

肺移植治疗终末期肺病18例报告

陈静瑜郑明峰朱艳红胡春晓何毅军王永功周敏陆国础陆明华【摘要】目的探讨国内开展临床肺移植的可行性以及目前存在的主要问题。方法2002年9月至2005年4月共完成临床肺移植18例,其中肺气肿9例、肺纤维化5例、矽肺1例、支气管肺扩张1例、肺淋巴管平滑肌瘤病1例及室间隔缺损合并艾森曼格综合征1例。受者术前均为重症呼吸衰竭,长期靠呼吸机依赖3例。手术方式为:单肺移植15例(左肺移植9例,右肺移植6例),其中2例受者的供肺为同一供者同期的左、右单肺,有1例为左侧供肺植入右胸腔,1例为体外循环下室间隔缺损修补后行右肺移植;非体外循环下序贯式双侧单肺移植3例。结果术后短期内死亡3例,1例于术后15d死于急性排斥,1例于术后30d死于感染后多脏器功能衰竭,1例术后36d死于肺梗死。其余15例均痊愈出院,肺功能明显改善,生存1年以上3例,生存2年以上2例,中位生存时间10个月。结论肺移植是治疗各种终末期肺病的有效的手段;但术后的缺血再灌注损伤、排斥反应和感染仍是肺移植短期死亡的主要原因。     

国际标准化脑死亡供肺的临床应用3例报告

目的总结适应我国国情的国际标准化脑死亡供体肺的获取以及应用于肺移植的经验。方法 3例机械通气分别达到3d、16d、12d的志愿捐献者经脑死亡和供体器官功能评估后,行国际标准化肺获取术。获取的双侧供肺分别为32岁、34岁、61岁的终末期肺病患者进行了双肺移植。结果利用3例脑死亡供肺成功进行了3例双肺移植,1例患者手术后第9日死于多器官功能衰竭,另外2例双肺移植患者术后恢复良好,顺利出院,术后随访生活质量良好,肺功能极大改善。结论在我国的条件下,严格按国际标准化获取脑死亡供肺,可作为肺移植的主要供肺来源之一。     

65岁以上终末期肺病患者肺移植疗效及预后分析

目的  探讨65岁以上终末期肺病患者肺移植的疗效及预后。方法  回顾性分析2002年9月至2011年12月南京医科大学附属无锡市人民医院收治的24例老年(≥65岁)肺移植病例的临床资料。了解老年肺移植患者的存活情况, 比较单肺和双肺移植的存活情况; 了解肺移植术后并发症及对随访期内死亡的病例进行死因分析。结果  所有患者肺移植手术均顺利完成。24例受者术后1、3、5、7年累积存活率分别为75.0%、62.5%、33.3%和12.5%, 其中单肺移植患者相应为68.8%、50.0%、31.3%和12.5%, 双肺移植患者相应为87.5%、87.5%、37.5%和12.5%。单肺与双肺移植患者中位生存时间分别为35、51个月, 两组生存期比较差异无统计学意义(P>0.05)。感染是术后最主要的并发症, 发生率为46%(11/24)。术后长期随访中17例死亡, 包括重症感染9例, 原发性移植物失功(PGD)1例, 急性排斥反应(AR)1例, 闭塞性细支气管炎(BOS)4例, 心力衰竭1例, 肿瘤1例。结论  单肺或双肺移植均是治疗老年终末期肺病的有效方法, 感染是老年受者术后最主要的并发症和死亡原因。     

同种异体单肺移植的围手术期处理——附11例临床报告

终末期肺病是肺移植最常见的病因，我院于2002年9月～2004年12月为11例终末期肺病患者成功进行了肺移植。本文就11例肺移植并结合文献复习，探讨肺移植的围手术期处理。     

肺移植手术的麻醉处理要点

肺移植手术作为终末期肺疾患治疗的一种方法，国内已经起步，但如何保障这些既往被列为麻醉禁忌患者的手术安全，对麻醉医生来说是一个挑战。我们总结了14例肺移植患者麻醉管理成败的经验，旨在探讨肺移植患者麻醉管理上的要点，以提高此类患者的手术安全性。     

供肺保护的研究进展

目前，肺移植已成为治疗终末期肺病的有效方法，但肺移植早期功能障碍的发生率仍在15％～20％。这与供肺保护的效果直接相关。现就供肺损伤的原因及保护方法的研究进展进行简要综述。     

肺移植四十年进展

肺移植是治疗终末期肺病的有效方法。本文就肺移植的发展概况、手术方式、适应证以及并发症的防治进展进行了综述。     

肺移植手术的麻醉处理一例

肺移植手术的麻醉处理一例欧阳川卿恩明耿新社李书闻作者单位：１０００２９北京安贞医院麻醉科患者．男，４７岁，５３ｋｇ。患者进行性呼吸困难３年、近１年来呼吸困难急剧加重。临床诊断：双肺广泛间质纤维化、肺气肿。麻醉及监测方法本例采用以芬太尼为主的静脉复合麻...     

从多伦多经验谈肺移植进展

1983年多伦多总院进行了全球首例成功的单肺移植，此后，随着供受者选择、肺保存技术、肺移植手术技术、围手术期管理和免疫抑制剂的进步，肺移植得以在全世界范围内广泛开展，术后早期生存率显著提高，肺移植也成为治疗终末期肺病可选择的惟一方法。近5年来，肺移植每年以1500例的速度在增长，而在2000年后全世界每年单、双肺移植的数量已经持平，2002年后双肺移植已超过单肺移植，至2004年底全世界共完成单、双肺移植约19000多例，术后1年生存率为76％。在肺移植发展的历程中，多伦多肺移植中心无论在临床研究还是基础研究均处于领先地位，现根据我们近年来在多伦多肺移植中心的学习体会，从多伦多肺移植经验谈一谈当今肺移植进展。     

肺移植手术中供肺保存液的研究现状

肺移植手术是治疗终末期肺部疾病的惟一有效方法，但仍然有许多相关问题须待解决。除了供肺严重缺乏外，因缺血-再灌注损伤导致的移植肺功能异常是肺移植手术患者最常见的早期死亡原因之一。保存移植肺的最佳状态对减轻肺移植术后缺血器官功能障碍至关重要。因此，寻找一种高度可靠的肺保存液，对减轻移植肺的缺血-再灌注损伤、提高肺移植术后肺功能有着十分重要的意义。现就供肺保存液的种类、灌注方式、灌注条件及其改良措施的研究现状进行综述。     

肺移植与肺减容术治疗终末期肺气肿的疗效分析

目的探讨肺移植和肺减容手术(LVRS)治疗终末期肺气肿患者的临床疗效及卫生经济学指标,为临床选择治疗方案提供参考。方法回顾性分析自2002年9月至2008年8月无锡市人民医院61例终末期肺气肿患者行LVRS和肺移植术治疗的临床资料,根据手术方式不同将61例患者分为3组,LVRS组:39例,行单侧肺减容术;单肺移植术(SLTx)组:14例,行SLTx;双肺移植术(BLTx)组:8例,行BLTx。于围术期、术后6个月、1年和3年住院复查肺功能、血气分析指标、6 min步行距离(6-MWD)的改变,观察1年、3年生存率。并通过成本-效用分析进行卫生经济学评价。结果术后6个月、1年和3年LVRS组、SLTx组和BLTx组FEV1.0较术前分别改善75%、83%和49%,176%、162%和100%,260%、280%和198%;LVRS组、SLTx组和BLTx组FVC分别较术前改善21%、41%和40%,68%、73%和55%,82%、79%和89%;LVRS组、SLTx组和BLTx组6-MWD分别较术前增加75%、136%和111%,513%、677%和608%,762%、880%和741%。LVRS组、SLTx组和BLTx组患者1年、3年生存率分别为74.40%和58.90%,85.80%和64.30%,62.50%和50.00%。SLTx组随访3年的成本-效用比高于BLTx组(1 668.00 vs.1 168.55,P<0.05)和LVRS组(1 668.00 vs.549.46,P<0.05)。结论 SLTx、BLTx组术后各项功能指标较LVRS组明显改善。3年内成本-效用分析结果表明,LVRS组更经济、实惠。随着医疗技术的进步、移植医疗费用的降低、免疫抑制剂的国产化价格降低,肺移植总费用也随之降低,肺移植术将成为终末期肺气肿患者首选的外科治疗方法。     

A Mouse Model of Orthotopic Vascularized Aerated Lung Transplantation

Outcomes after lung transplantation are markedly inferior to those after other solid organ transplants. A better understanding of cellular and molecular mechanisms contributing to lung graft injury will be critical to improve outcomes. Advances in this field have been hampered by the lack of a mouse model of lung transplantation. Here, we report a mouse model of vascularized aerated single lung transplantation utilizing cuff techniques. We show that syngeneic grafts have normal histological appearance with minimal infiltration of T lymphocytes. Allogeneic grafts show acute cellular rejection with infiltration of T lymphocytes and recipient-type antigen presenting cells. Our data show that we have developed a physiological model of lung transplantation in the mouse, which provides ample opportunity for the study of nonimmune and immune mechanisms that contribute to lung allograft injury.     

One and One-Half Year Experience with Unilateral and Bilateral Lung Transplantation

Lung transplantation has now become an established form of treatment for end-stage pulmonary parenchymal and vascular diseases. Despite its wide acceptance, technical aspects are still in discussion. We report on the initiation of our own lung transplant program and the technical changes we have performed during our first 1 1/2-year experience. During that period of time, we have performed 26 lung transplantations (16 single lung [SLTX] and 10 bilateral lung transplantations [BLTX]). Three-month survival for the whole group was 74% (69% for the SLTX group and 77% for the BLTX group). No instance of bronchial dehiscence was observed; however, there were eight cases of bronchial stenosis: six were managed by silicone stent insertion, one by bronchoplastic correction, and one by retransplantation. Changes in the technique of the bronchial anastomosis together with the addition of prednisone to the immediate postoperative immunosuppressive regime resulted in almost complete avoidance of these problems.     

Simplified Rat Lung Transplantation by Using a Modified Cuff Technique

Mizuta's cuff technique in rat lung transplantation (LT) model has some disadvantages, such as twisting of blood vessels or bronchus and being time-consuming, which complicate procedures for anastomosis. This study was performed to investigate the advantage of using a simplified cuff technique in LT. The anastomosis time was compared in two groups. In group I, Mizuta'scuff technique was performed in 50 rat orthotopic left lung transplants. In group II, a simple modified cuff technique was performed in 48 rat orthotopic left lung transplants. The successful rate of the new technique for anastomosis was 100%. No twist of vessels or bronchus and no bleeding or air leakage were observed in group II. The anastomosis time of group II was significantly less than for group I (11.2 ± 2.1 min vs. 18.1 ± 3.6 min, mean ± SD, p <. 01). This simple modified cuff technique led to less anastomosis time and avoided potential complications induced by the cuff-tail technique. It has been verified to be a safe, simple, and reproducible technique that can provide us with a more precise assessment in the rat LT model.     

Kidney Disease After Heart and Lung Transplantation

Kidney disease is a commonly recognized complication of heart and lung transplantation and is associated with increased morbidity and mortality. While the spectrum of kidney disease in this population is wide-ranging, studies indicate that between 3% and 10% of these patients will ultimately develop end-stage renal disease (ESRD). This review examines the risk factors for both acute and chronic kidney injury, with a particular emphasis on the role of calcineurin inhibitor-mediated nephrotoxicity in both these settings. Against the background of current National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, we have further considered and recommended appropriate strategies for long-term management of kidney disease-related manifestations in heart and lung transplant recipients. Specific aspects addressed include retarding progressive renal injury and minimizing nephrotoxicity, as well as treatment of hypertension, hyperlipidemia and anemia. Finally, for patients in this population with advanced kidney disease, renal replacement therapy options are discussed. Based on the impact of chronic kidney disease on outcomes in both heart and lung recipients, we advocate early referral to a nephrologist for patients displaying evidence of significant renal dysfunction.     

Successful Bilateral Lung Transplantation for Lymphangiomatosis

Lymphangiomatosis is a rare disease of lymphatic proliferation for which no adequate treatment is known. We report the first successful case of bilateral lung transplantation for the treatment of end-stage pulmonary lymphangiomatosis. A successful outcome was achieved with continued survival beyond 4 years posttransplant and stable lung function. The primary obstacles to significant gains in pulmonary function were thoracic, skeletal and abdominal lymphangiomatosis, which led to pulmonary restriction. Our report demonstrates that pulmonary lymphangiomatosis should be included among those diseases for which lung transplantation is considered potentially beneficial treatment but also emphasizes the importance of screening patients carefully for chest wall and abdominal lymphangiomas that may impede recovery.