再次肺移植手术技术及围手术期诊疗策略的探讨—附1例病例分析

发布时间：2018-04-12 13:57

本文选题：再次肺移植 + 手术技术　；参考：《浙江大学》2013年博士论文

【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。
[Abstract]:Background Lung transplantation is one of the main methods for the treatment of end-stage lung disease. Clinical lung transplantation was first carried out in China in 1979, and the first single lung transplant was successfully performed in China in 1996. It was only gradually succeeded in a few hospitals in China since 2003.And the failure rate is still high.Re lung transplantation is the only effective treatment after transplant lung failure, but its clinical value is still controversial.The technique of re-transplantation and the strategy of perioperative diagnosis and treatment were discussed.Objective re-transplantation of lung is the only effective treatment after transplanted lung failure.To discuss the technique of re-transplantation and the strategy of diagnosis and treatment in the perioperative period of lung transplantation.Methods in August 2011, the first affiliated Hospital of Zhejiang University Medical College completed a reoperation of lung transplantation for the first time. Five years after single lung transplantation, the patients suffered from graft dysfunction due to bronchiolitis obliterans.The operation was performed by contralateral single lung transplantation. Extracorporeal membrane lung was used to assist the operation. Pulmonary edema, immunosuppression and anti-infection were treated after operation.Results the operative time was 1: 143 min, the cold ischemia time was 1: 140 min, and the intraoperative bleeding was 2 850 m 1.Hemodynamic monitoring and respiratory management were performed, tracheal intubation was removed within 24 hours after operation, and the second general turnover ward was discharged at the fifth week after operation. All the indexes were satisfactory.Conclusion Re-transplantation is an effective method for the treatment of transplanted lung failure. The key to success of lung transplantation is to strictly grasp the indication of operation, to select the recipient reasonably, to have a good operative technique and to manage the lung transplantation in the perioperative period.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R655.3

【相似文献】