Interventional bronchoscopy for the management of airway complications following lung transplantation
Interventional bronchoscopy for the management of airway complications following lung transplantation
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DOI：
10.1378/chest.120.6.1894
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发表时间：
2001-12-01
期刊：
影响因子：
9.6
通讯作者：
Glanville, AR
中科院分区：
文献类型：
--
作者：
Chhajed, PN;Malouf, MA;Glanville, AR
研究目的：评估不同介入支气管镜技术用于治疗肺移植术后气道并发症的疗效和并发症。设计：回顾性研究。设置：大学医院心肺移植病房。患者：1986年11月至2000年1月，对312例肺移植受者中的41例进行了介入性支气管镜检查（13.1%）用于气管支气管狭窄、支气管软化、肉芽肿形成和裂开。干预措施：扩张、支架置入、激光或镊子切除。测量和结果：26例因狭窄或合并病变接受扩张的患者的FEV 1平均（+/- SE）改善为93 +/- 334 mL或8 +/-21%。在其中7例未进行支架置入术的患者中，FEV 1的平均改善为361 +/- 179 mL或21 +/-9%。扩张后需要置入支架的患者，扩张后FEV 1的平均变化为- 5 +/- 325 mL或3 +/-23%，支架置入后改善为625 +/- 180 mL或52 +/- 43%。接受Strong插入治疗支气管软化的患者的FEV 1平均改善为673 +/- 30 mL或81 +/-24%。气道柄的并发症为移位（27%）、粘液堵塞（27%）、肉芽肿形成（36%）、气管断裂（3%）和假通道形成（6%）。与介入性支气管镜检查相关的死亡率为2.4%（1/1例患者）。对于成功接受介入支气管镜检查的气道并发症患者，总的1年、3年和5年生存率分别为79%、45%和32%，而无气道并发症的患者分别为87%、69%和56结论：只有少数肺移植术后气道狭窄的患者，单纯支气管扩张术才有疗效。肺移植术后发生气道并发症的患者死亡率高于无气道并发症的患者。
Study objectives: To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation.Design: Retrospective study.Setting: Heart-lung transplant unit of a university hospital.Patients: From November 1986 to January 2000, interventional bronchoscopy was performed in 41 of 312 lung transplant recipients (13.1%) for tracheobronchial stenosis, bronchomalacia, granuloma formation, and dehiscence.Interventions: Dilatation, stent placement, laser or forceps excision.Measurements and results: Mean (+/- SE) improvement in FEV1 in 26 patients undergoing dilatation for a stenotic or a combined lesion was 93 +/- 334 mL or 8 +/- 21%. In seven of these patients not proceeding to stent placement, mean improvement in FEV1, was 361 +/- 179 mL or 21 +/- 9%. Patients needing stent placement after dilatation had a mean change in FEV1 after dilatation of - 5 +/- 325 mL or 3 +/- 23%, and an improvement of 625 +/- 180 mL or 52 +/- 43% after stent insertion. Mean improvement in FEV1 for patients treated with stout insertion for bronchomalacia was 673 +/- 30 mL or 81 +/- 24%. Complications of airway stems were migration (27%), mucous plugging (27%), granuloma to formation (36%), scent fracture (3%), and formation of a false passage (6%). Mortality associated with interventional bronchoscopy was 2.4 % (1 of 1 patients). For patients with airway complications successfully undergoing interventional bronchoscopy, the overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and 32%, respectively, vs 87%, 69%, and 56% for those without airway complications (p < 0.05).Conclusion: Only a small number of patient, with airway stenosis after lung transplantation will respond to bronchial dilatation alone. Patients with airway complications after lung transplantation have a higher mortality than patients without airway complications.