Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience
Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience
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DOI：
10.1007/s00405-012-2002-y
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发表时间：
2013-01-01
影响因子：
2.6
通讯作者：
Holzmann, David
中科院分区：
文献类型：
--
作者：
Vital, Domenic;Hofer, Markus;Holzmann, David
据推测，慢性鼻窦炎在患有囊性纤维化的肺移植受者中发挥着重要作用。鼻旁窦被认为积聚了大量细菌，可能导致肺同种异体移植物感染，并随之发生并发症，例如闭塞性细支气管炎综合征，即同种异体移植物排斥。因此，我们想介绍我们的药物和手术相结合的治疗计划，其中包括内窥镜额蝶筛切除术以及细致的日常鼻部护理计划。微生物学结果表明，我们的综合概念是有效的，而特别是使用等渗盐水溶液的日常鼻护理是防止鼻窦明显定植并将细菌传播到下呼吸道导致肺同种异体移植物感染的基石。关于我们治疗的手术部分，应该强调的是，所有鼻窦和筛窦都要张开。应平滑骨突出等边缘，以避免粘液滞留和连续的细菌重新定植，从而需要随后的修复手术。
Chronic rhinosinusitis is hypothesised to play a major role in lung transplant recipients with cystic fibrosis. Paranasal sinuses are considered to accumulate a significant bacterial load, potentially leading to lung allograft infection with ensuing complications such as bronchiolitis obliterans syndrome, i.e. allograft rejection. We therefore would like to present our combined medical and surgical treatment plan, which consists of an endoscopic fronto-spheno-ethmoidectomy as well as a meticulous daily nasal care program. The microbiological results show that our combined concept is effective, whereas especially daily nasal care with isotonic saline solution is the cornerstone in preventing significant colonisation of the sinuses and spreading bacteria to the lower respiratory tract causing lung allograft infection. Regarding the surgical part of our treatment, it should be emphasised that all sinuses and ethmoidal air cells should be widely opened. Edges such as bony overhangs should be smoothened to avoid mucus retention and consecutive bacterial recolonisation requiring subsequent revision surgery.