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[1]郭 强,陈 成,宋永祥,等.西部遵义(非省会城市)首次开展肺移植术在终末期肺部良性疾病中的应用[J].遵义医科大学学报,2019,42(05):572-575.
 Guo Qiang,Chen Cheng,Song Yongxiang,et al.Application of lung transplantation for the first time in Zunyi(non-provincial capital city)in western China for end-stage pulmonary benign diseases[J].Journal of Zunyi Medical University,2019,42(05):572-575.
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西部遵义(非省会城市)首次开展肺移植术在终末期肺部良性疾病中的应用()
     
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《遵义医科大学学报》[ISSN:1000-9035/CN:22-1262/O4]

卷:
第42卷
期数:
2019年05期
页码:
572-575
栏目:
临床经验交流
出版日期:
2019-10-25

文章信息/Info

Title:
Application of lung transplantation for the first time in Zunyi(non-provincial capital city)in western China for end-stage pulmonary benign diseases
文章编号:
1000-2715(2019)05-0572-04
作者:
郭 强陈 成宋永祥李 剑汤 阳瞿文栋陈安平韩 旭左杰斌徐 刚
(遵义医科大学附属医院 胸外科,贵州 遵义 563099)
Author(s):
Guo QiangChen ChengSong YongxiangLi JianTang YangQu WendongChen AnpingHan XuZuo JiebinXu Gang
(Department of Thoracic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China)
关键词:
肺移植 终末期肺部良性疾病 肺部感染
Keywords:
lung transplantation end-stage pulmonary benign disease pulmonary infection
分类号:
R617
DOI:
-
文献标志码:
B
摘要:
目的 探讨在西部非省会城市开展肺移植术及影响肺移植手术成功率的主要因素。方法 2017年以来遵义医科大学附属医院累计开展7例肺移植术,供体来源:2例脑死亡器官捐献(Donation after brain death,DBD)供体来自贵州省外,5例DBD供体来自贵州省内。3例受体因肺气肿行序贯式双肺移植,4例受体行单肺移植术。术后受体均在24 h内脱离有创呼吸机,使用他克莫司+骁悉+糖皮质激素抗排斥,并预防性使用广谱抗生素+抗真菌+抗病毒药物预防继发感染。结果 外省供体冷缺血时间为6~7 h,省内供体冷缺血时间为0~1 h。4例单肺移植冷缺血时间为(75±45)min,3例双肺移植冷缺血时间为(140±20)min。7例肺移植受体术后3d的出量均大于入量。7例受体术后3d的PaO2均高于术前,而术前术后PaCO2变化不明显。1例受体术后出现气道吻合口狭窄,经纤维镜吻合口气管清除支气管肉芽+球囊扩张+覆膜支架植入术治疗后痊愈。1例受体术后发生急性排斥反应,2例受体术后出现慢性排斥反应。移植术后有6例受体存在肺部细菌感染,其中1例省外供体来源的受体合并有真菌感染,在术后20 d时因肺部感染死亡,其余受体均痊愈出院,肺功能明显改善,随访至今恢复良好。结论 西部非省会城市开展肺移植术应在经验更丰富的肺移植中心指导及协助下,逐步建立好规范化流程,就近维护及利用省内的潜在标准供体,缩短冷缺血时间,加强围术期的规范管理,是保证移植受体恢复的重要因素。
Abstract:
ObjectiveTo explore the main factors influencing the success rate of lung transplantation in non-provincial cities in western China.Methods A total of 7 cases of lung transplantation had been collected in the First Affiliated Hospital of Zunyi Medical University.Among them,five donors of donation after brain death(DBD)were from Guizhou province,while the other 2 donors were from the other provinces.Three recipients received sequential double lung transplantation for emphysema,and four recipients received single lung transplantation.Invasive ventilators were removed for all the recipients after surgery within 24 h.Tacrolimus,cellcept and glucocorticoid were used in combination to prevent immune rejection,and combination of broad-spectrum antibiotics,antifungal and antiviral drugs were prophylactically applied to prevent secondary infection.Results The cold ischemia time of donors in other provinces were 6~7 h,and that within provinces was 0~1 h.Cold ischemia time was(75±45)min in 4 patients with single lung transplantation and(140±20)min in 3 patients with double lung transplantation.The output of 7 patients was greater than the input 3 days after lung transplantation.The PaO2 of 7 patients 3 days after the operation was higher than that before the operation.However,PaCO2 did not change significantly in the whole process.One patient with anastomotic stenosis of the airway after the operation was cured by clearing granulation tissue of bronchus anastomotic,balloon dilatation and implantation of membrane covered stent.Acute immune rejection occurred in 1 patient and chronic immune rejection occurred in 2 patients.After the transplantation,six recipients had pulmonary bacterial infection,among which 1 recipient with donor source from other province had a fungal infection,and died of pulmonary infection 20 days after the surgery.All the remaining receptors recovered and were discharged,with significant improvement in lung function,and recovered well until now.Conclusion In order to protect and utilize potential donors in the province nearby,shorten blood cooling time and strengthen perioperative standardized management,standardized procedures should be gradually established for lung transplantation in non-provincial cities in western China under the guidance and assistance of more experienced lung transplantation centers,thereby the recovery of transplant recipients could be ensured.

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备注/Memo

备注/Memo:
[基金项目]卫生部科技计划项目(NO:W2012RQ43)。 [通信作者]徐刚,男,硕士,教授,硕士生导师,研究方向:肺癌基础与临床,E-mail:xglhl333@163.com。
更新日期/Last Update: 2019-10-25