AIRWAY COMPLICATIONS IN LUNG TRANSPLANTATION
AIRWAY COMPLICATIONS IN LUNG TRANSPLANTATION
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DOI：
10.1016/0003-4975(94)91038-3
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发表时间：
1994-02-01
影响因子：
4.6
通讯作者：
MASSARD, G
中科院分区：
文献类型：
--
作者：
SHENNIB, H;MASSARD, G
本文就肺移植术后气道愈合的相关文献作一综述。从历史的角度来看，从1963年首次尝试单肺移植到20世纪80年代初的临床成功，这一直是肺移植的致命弱点。致死性气道并发症的总体发生率估计为2%至3%，而晚期狭窄的发生率为7%至14%。在没有通用分类的情况下，很难比较经验;提出了一种新的气道和吻合口并发症和愈合分类。缺血似乎是影响气道愈合的最重要因素。现在来自肺动脉的低压支气管侧支血液可能受到低心输出量、再灌注水肿或排斥反应的影响;长时间正压通气可能进一步增加粘膜损伤。良好的支气管愈合似乎是可能的，没有保护性包裹和早期使用类固醇。支气管并发症的管理具有挑战性，需要内窥镜技能，包括支气管内激光光凝和支架插入技术的知识。
This article reviews the literature on airway healing after lung transplantation. From a historical point of view, this has been the Achilles' heel of lung transplantation through two decades, from the first attempt at single-lung transplantation in 1963 to the clinical successes in the early 1980s. The overall incidence of lethal airway complications is estimated to be 2% to 3%, whereas that of late stricture is 7% to 14%. Comparison of experiences has been difficult without a universal classification; a new classification for airway and anastomotic complications and healing is proposed. Ischemia appears to be the most important factor influencing airway healing. Low-pressure collateral bronchial blood now from the pulmonary artery may be affected by low cardiac output, reperfusion edema, or rejection; mucosal injury may be further increased by prolonged positive-pressure ventilation. Good bronchial healing appears to be possible without a protective wrap and with early use of steroids. The management of bronchial complications is challenging and requires endoscopic skills including knowledge of endobronchial laser photocoagulation and stent insertion techniques.