【作者】 洪誉鹏；

【导师】 胡坚；

【作者基本信息】 浙江大学 ， 心胸外科学（专业学位）， 2013， 博士

【摘要】 背景肺移植是目前治疗终末期肺病的主要方法之一,我国于1979年首先开展临床肺移植手术,1996年我国首例临床单肺移植手术成功。2003年开始才逐步在全国少数几家医院成功,而且失败率仍然很高。再次肺移植是移植肺衰竭后唯一有效的治疗手段,但目前对其临床价值还有很多争议,我们通过1例再次肺移植患者的病例分析,对再次肺移植手术技术及围手术期诊疗策略进行初步探讨。目的再次肺移植是移植肺衰竭后唯一有效的治疗手段。探讨再次肺移植手术技术及肺移植围手术期的诊疗策略。方法浙江大学医学院附属第一医院于2011年8月首次完成1例再次肺移植手术,患者系单肺移植后5年因闭塞性细支气管炎导致移植物失功。手术方式为对侧单肺移植,选择体外膜肺术中辅助,术后予以控制肺水肿、免疫抑制、抗感染等治疗。结果本例患者顺利接受手术,手术时间为：143min,冷缺血时间为：140min,术中出血为2850m1。术后予以血流动力学监测及呼吸管理,患者术后24小时内拔除气管插管,术后第2周转普通病房,并于术后第5周出院,术后至今随访18个月,目前各项指标均满意。结论再次肺移植是治疗移植肺功能衰竭的有效手段,严格把握手术适应证,合理选择受者,良好的手术操作技术及合理的围手术期诊疗管理是肺移植手术成功的关键。更多还原

【Abstract】 BackgroundLung transplantation is on of the most important treatments for end-stage respiratory failure. Although lung retransplantation is the only definitive theraputic option in lung recipients with bronchiolitis obliterans syndrome after lung transplantation, its value remains a considerable source of controversy. Here we share our experience of surgical techniques and perioperative managements of lung retransplantation performed in our center.ObjectiveTo discuss the surgical techniques and perioperative treatment strategies of lung retransplantationMethodWe performed the fisrt case of lung retransplantation to treat a patient of graft dysfunction with bronchiolitis obliterans syndrome in the First Affiliated Hospital of College of Medicine of Zhejiang University on August2011. The surgical approache was contralateral single-lung transplantation, aided by extracorporeal membrane oxygenation. ResultsThe patient was successfully received surgery, and the operative time was143min.The cold ischemia time was140min. The blood loss volume during the operation was2850ml. After operation the patient was treated with control of pulmonary edema, immunosuppressive, anti-infection therapy. The patient was extubated within24hours, and then transferred to general ward in2weeks, and discharge in five weeks. Until now all the perioperative indicators of the patients are satisfied.ConclusionWith strictly controlled indications, properly selected lung recipents,advanced surgical techniques and perioperative managements, lung retransplantation is a safe and effective therapeutic option in lung recipents with bronchiolitis obliterans syndrome after lung transplantation.更多还原