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肺移植术后气道吻合口狭窄的诊治进展

刘明昭 史灵芝 杨航 卫栋 范立 吴波 陈静瑜

刘明昭, 史灵芝, 杨航, 等. 肺移植术后气道吻合口狭窄的诊治进展[J]. 器官移植, 2021, 12(5): 533-538. doi: 10.3969/j.issn.1674-7445.2021.05.005
引用本文: 刘明昭, 史灵芝, 杨航, 等. 肺移植术后气道吻合口狭窄的诊治进展[J]. 器官移植, 2021, 12(5): 533-538. doi: 10.3969/j.issn.1674-7445.2021.05.005
Liu Mingzhao, Shi Lingzhi, Yang Hang, et al. Diagnosis and treatment progress on airway anastomotic stenosis after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(5): 533-538. doi: 10.3969/j.issn.1674-7445.2021.05.005
Citation: Liu Mingzhao, Shi Lingzhi, Yang Hang, et al. Diagnosis and treatment progress on airway anastomotic stenosis after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(5): 533-538. doi: 10.3969/j.issn.1674-7445.2021.05.005

肺移植术后气道吻合口狭窄的诊治进展

doi: 10.3969/j.issn.1674-7445.2021.05.005
基金项目: 

江苏省科教强卫项目 JCRCB2016003

无锡市社会发展科技示范工程项目 WX18IVJN015

详细信息
    通讯作者:

    史灵芝,女,副主任医师,研究方向为肺移植临床研究,E-mail: shilingzhi1979@126.com

    陈静瑜,男,主任医师,研究方向为肺移植,E-mail: chenjy@wuxiph.com

  • 中图分类号: R617, R619

Diagnosis and treatment progress on airway anastomotic stenosis after lung transplantation

More Information
  • 摘要: 肺移植是治疗多数终末期肺病的唯一有效手段, 而气道吻合口并发症是限制肺移植受者术后存活及生存质量的主要障碍。气道吻合口狭窄是肺移植术后最常见的气道吻合口并发症。近年来,受者选择、器官保存、外科技术、术后重症监护管理、免疫抑制、抗真菌及内镜治疗等方面的改进,降低了气道吻合口狭窄的发生率,改善了肺移植手术结果和受者生存情况。现就肺移植术后气道吻合口狭窄的病因及危险因素、诊断与治疗进行综述,为临床研究和诊疗肺移植术后气道吻合口狭窄提供新的思路。

     

  • 图  1  气道吻合口狭窄的支气管镜下表现

    注:A图示吻合口区狭窄,支气管横截面面积减少0~25%(程度a);B图示吻合口区狭窄,支气管横截面面积减少26%~50%(程度b);C图示吻合口区狭窄,支气管横截面面积减少51%~100%(程度c);D图示吻合口区狭窄,支气管完全闭塞(程度d);E图示吻合口及远端支气管狭窄,支气管完全闭塞(程度d);F图示吻合口及远端支气管狭窄,支气管横截面面积减少51%~100%(程度c),BI为中间段支气管,RUL为右上叶支气管;G图示仅远端叶、段支气管狭窄,支气管横截面面积减少26%~50%(程度b);H图示仅远端叶、段支气管狭窄(右中叶),支气管横截面面积减少51%~100%(程度c)。

    Figure  1.  The bronchoscopy manifestation of airway anastomotic stenosis

    表  1  治疗支气管狭窄的支架类型

    Table  1.   Stent option for bronchial stenosis

    支架类型 优点 缺点
    自膨式金属内支架 清醒镇静下支气管镜放置、即时缓解及功能改善、不易迁移、黏液堵塞较少 细菌和真菌定植率高、易形成肉芽组织导致再狭窄、气道侵蚀、金属支架疲劳断裂、支气管血管瘘导致致命咯血
    硅胶支架 易放置和适应、可修剪和定制、肉芽组织形成率低、易于移除 需硬性支气管镜检查和全身麻醉下放置、厚壁和狭窄的管腔易造成分泌物梗阻、易迁移
    复合型支架 易放置和适应、可修剪和定制、易于移除 需硬性支气管镜检查和全身麻醉下放置、易迁移
    生物可降解支架 肉芽组织形成率低、感染性定植发生率低 需硬性支气管镜检查和全身麻醉下放置、再狭窄致使反复支架放置
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-05-25
  • 网络出版日期:  2021-09-15
  • 刊出日期:  2021-09-15

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