Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis.
Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis.
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DOI：
10.1513/pats.200808-094go
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发表时间：
2009-01-15
期刊：
影响因子：
--
通讯作者：
Mehta, Atul C
中科院分区：
文献类型：
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作者：
Santacruz, Jose Fernando;Mehta, Atul C
自从首次人类肺移植以来，肺移植的总体存活率有所提高。气道并发症（AC）发生率的下降是实现当前结局的关键特征。从手术技术到免疫抑制方案，已经确定了几个可能导致气道并发症的危险因素。肺移植后主要有六种不同的气道并发症。最常报告的并发症是支气管狭窄。其他并发症包括支气管裂开、外生性肉芽组织过多形成、气管支气管软化、支气管瘘和支气管内感染。移植后支气管并发症的管理需要多专业团队的方法。通过早期和积极的医疗管理以及使用某些移植手术技术，可以预防某些并发症。介入性支气管镜手术，包括球囊支气管成形术、冷冻疗法、激光光切除术、电烙术、高剂量支气管内近距离放射治疗和支气管支架都是最常用的方法。此外，医学管理，如抗生素预防和治疗支气管内感染，或无创正压通气的情况下，支气管软化，用于治疗AC。在某些情况下，偶尔需要不同的手术方法。本文就肺移植术后最常见的AC的危险因素、临床表现、诊断方法以及治疗方法进行综述。
Overall survival rates of lung transplantation have improved since the first human lung transplantation was performed. A decline in the incidence of airway complications (AC) had been a key feature to achieve the current outcomes. Several proposed risk factors to the development of airway complications have been identified, ranging from the surgical technique to the immunosuppressive regimen. There are essentially six different airway complications post-lung transplantation. The most frequently reported complication is bronchial stenosis. Other complications include bronchial dehiscence, exophytic excessive granulation tissue formation, tracheo-bronchomalacia, bronchial fistulas, and endobronchial infections. The management of post-transplant bronchial complications needs a multispecialty team approach. Prevention of some complications may be possible by early and aggressive medical management as well as by using certain surgical techniques for transplantation. Interventional bronchoscopic procedures, including balloon bronchoplasty, cryotherapy, laser photoresection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents are among the armamentarium. Also, medical management, like antibiotic prophylaxis and therapy for endobronchial infections, or noninvasive positive-pressure ventilation in case of bronchomalacia, are used to treat an AC. In some cases, different surgical approaches are occasionally required. In this article we review the risk factors, the clinical presentation, the diagnostic methods, as well as the management options of the most common AC after lung transplantation.