Airway complications after lung transplantation:: a review of 151 anastomoses
Airway complications after lung transplantation:: a review of 151 anastomoses
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DOI：
10.1016/s1010-7940(01)00619-4
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发表时间：
2001-04-01
影响因子：
3.4
通讯作者：
Salvatierra, A
中科院分区：
文献类型：
--
作者：
Alvarez, A;Algar, J;Salvatierra, A
目的：分析肺移植术后气道并发症的发生情况、治疗及随访情况。方法：自1993年10月至2000年4月，对101例患者进行104例肺移植手术。该研究纳入了 151 个有风险的支气管吻合（29 个单肺和 61 个连续双肺）。用 Eurocollins 顺行和逆行冲洗供体肺。在接受者中，根据需要进行单次或连续双侧肺移植。在所有病例中，支气管吻合口均被套叠并被支气管周围组织覆盖。术后纤维支气管镜检查根据临床情况决定。记录并分析接受者变量，以评估复杂组和非复杂组之间可能存在的差异。结果：6例患者（6.8%）发生8例支气管吻合并发症（5.3%）。所有复杂病例均发生在连续双侧肺受者中（P = 0.08）：狭窄（n = 5）、肉芽组织（n = 2）和支气管裂开（n = 1）。治疗包括一名患者进行肺叶切除术和随后的全肺切除术，两名患者进行硬性支气管镜扩张，两名患者进行球囊支气管扩张，一名患者进行激光清创和支架置入术，以及两名患者进行保守治疗。一名患有严重脓毒症和支气管裂开的患者于第 30 天死亡。其余患者至今情况良好。气道并发症与插管时间较长有关（P < 0.01）。其他围手术期供体和受体因素，包括感染和急性排斥反应的发生率以及精算生存率，在各组之间没有差异。结论：根据我们的经验，半月移植后气道并发症的发生率为 5.3%。仔细的手术技术和器官保存、对排斥和感染的密切监测以及术后早期拔管可能有助于降低这种发生率。手术治疗或支气管镜扩张和支架置入方法可能有助于解决这些并发症。 (C) 2001 Elsevier Science B.V. 保留所有权利。
Objective: To analyze the incidence, treatment and follow up of airway complications after lung transplantation. Methods: From October 1993 to April 2000, 104 lung transplants were performed in 101 patients. One hundred and fifty one bronchial anastomoses at risk were included in the study (29 single lung and 61 sequential double lung). Donor lungs were flushed both antegradely and retrogradely with Eurocollins. in the recipients, either a single or a sequential bilateral lung transplantation was performed when indicated. The bronchial anastomosis was telescoped and covered with peribronchial tissue in all cases. Postoperative fiberoptic bronchoscopic examinations were dictated by clinical grounds. Recipient variables were recorded and analyzed to assess possible differences between both complicated and non-complicated groups. Results: Eight bronchial anastomotic complications (5.3%) occurred in six patients (6.8%). All complicated cases developed in sequential bilateral lung recipients (P = 0.08): stenosis (n = 5), granulation tissue (n = 2), and bronchial dehiscence (n = 1). Treatment consisted of lobectomy and subsequent completion pneumonectomy in one patient, rigid bronchoscopy dilation in two, balloon bronchodilation in two, laser debridement and stenting in one, and conservative therapy in two cases. One patient with severe sepsis and bronchial dehiscence died on day + 30. The rest of the patients remain well so far. Airway complications were related to longer intubation periods (P < 0.01). Other perioperative donor and recipient factors including the incidence of infections and acute rejection episodes, and actuarial survival, did not differ between groups. Conclusion: In our experience, the incidence of airway complications after lune transplantation is 5.3%. The careful surgical technique and organ preservation, the close surveillance of rejection and infection, and early postoperative extubation might play a role in reducing this incidence. Either surgical therapy or bronchoscopic dilation and stenting methods may contribute to resolve these complications. (C) 2001 Elsevier Science B.V. All rights reserved.