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Clamshell切口和双侧后外侧切口开胸行双肺移植的临床效果比较

陈员, 熊点, 徐坚, 等. Clamshell切口和双侧后外侧切口开胸行双肺移植的临床效果比较[J]. 器官移植, 2022, 13(6): 770-775. doi: 10.3969/j.issn.1674-7445.2022.06.012
引用本文: 陈员, 熊点, 徐坚, 等. Clamshell切口和双侧后外侧切口开胸行双肺移植的临床效果比较[J]. 器官移植, 2022, 13(6): 770-775. doi: 10.3969/j.issn.1674-7445.2022.06.012
Chen Yuan, Xiong Dian, Xu Jian, et al. Comparison of clinical efficacy between Clamshell incision and bilateral posterolateral incision for double lung transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 770-775. doi: 10.3969/j.issn.1674-7445.2022.06.012
Citation: Chen Yuan, Xiong Dian, Xu Jian, et al. Comparison of clinical efficacy between Clamshell incision and bilateral posterolateral incision for double lung transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 770-775. doi: 10.3969/j.issn.1674-7445.2022.06.012

Clamshell切口和双侧后外侧切口开胸行双肺移植的临床效果比较

doi: 10.3969/j.issn.1674-7445.2022.06.012
基金项目: 

国家自然科学基金面上项目 82070059

详细信息
    作者简介:
    通讯作者:

    叶书高,硕士,主任医师,研究方向为肺移植,Email: ysg206@hotmail.com

    陈静瑜,硕士,主任医师,研究方向为肺移植,Email: chenjy@wuxiph.com

  • 中图分类号: R617

Comparison of clinical efficacy between Clamshell incision and bilateral posterolateral incision for double lung transplantation

More Information
  • 摘要:   目的  探讨Clamshell切口和双侧后外侧切口序贯双肺移植术治疗终末期肺病的疗效差异。  方法  回顾性分析接受双肺移植的120例受者的临床资料,按照手术方式不同分为双侧后外侧切口组(108例)和Clamshell切口组(12例)。收集并比较两组术中相关指标,包括手术时间、出血量、输血量、是否体外膜肺氧合(ECMO)支持、第一侧冷缺血时间、第二侧冷缺血时间,同时比较两组术后相关指标,包括住院时间、重症监护室(ICU)入住时间、气管插管时间、ECMO支持时间、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、吻合口狭窄发生率、支气管胸膜瘘发生率、围手术期病死率、术后第1次6 min步行距离。  结果  Clamshell切口组出血量、输血量均多于双侧后外侧切口组(均为P < 0.05),Clamshell切口组ECMO支持率和第二侧冷缺血时间低于或短于双侧后外侧切口组(均为P < 0.05)。Clamshell切口组气管插管时间及ECMO支持时间均短于双侧后外侧切口组(均为P < 0.05)。  结论  Clamshell切口和双侧后外侧切口的手术方案应用于序贯双肺移植均安全有效,双侧后外侧切口在不明显增加手术时间的情况下,可显著减少受者的出血量和输血量。而与双侧后外侧切口比较,Clamshell切口供肺冷缺血时间、气管插管时间和ECMO支持时间显著缩短。

     

  • 表  1  两组受者术中相关指标的比较

    Table  1.   Comparison of intraoperative indexes of recipients between the two groups

    指标 双侧后外侧切口组(n=108) Clamshell切口组(n=12) P
    手术时间(x ± s,min) 422±65 404 ±113 0.599
    出血量[MP25P75),mL] 1 200(800,1 781) 2 025(1 544,3 038) 0.001
    输血量[MP25P75),mL] 1 200(800,1 500) 2 000(1 500,3 000) < 0.001
    ECMO支持率[n(%)] 100(93) 8(67) 0.020
    第一侧冷缺血时间(x ± s,min) 382±84 395±104 0.602
    第二侧冷缺血时间(x ± s,min) 541±89 482±113 0.037
    下载: 导出CSV

    表  2  两组受者术后相关指标的比较

    Table  2.   Comparison of postoperative indexes of recipients between the two groups

    指标 双侧后外侧切口组(n=108) Clamshell切口组(n=12) P
    住院时间[MP25P75),d] 37(25,59) 31(25,42) 0.505
    ICU入住时间[MP25P75),d] 6(4,10) 6(3,10) 0.745
    气管插管时间[MP25P75),h] 44(40,92) 24(17,34) 0.002
    ECMO支持时间[MP25P75),h] 20(15,49) 0(0,26) 0.019
    FVC[MP25P75),L] 2.3(1.9,2.8) 1.9(1.5,2.7) 0.477
    FEV1[MP25P75),L] 1.9(1.6,2.3) 1.8(1.3,2.4) 0.726
    吻合口狭窄发生率[n(%)] 28(26) 2(17) 0.725
    支气管胸膜瘘发生率[n(%)] 2(2) 1(8) 0.273
    围手术期病死率[n(%)] 15(14) 1(8) 0.929
    术后第1次6 min步行距离(x ± s,m) 435±119 443±133 0.898
    下载: 导出CSV
  • [1] ZHOU J, CHEN J, WEI Q, et al. The role of ischemia/reperfusion injury in early hepatic allograft dysfunction[J]. Liver Transpl, 2020, 26(8): 1034-1048. DOI: 10.1002/lt.25779.
    [2] BOS S, VOS R, VAN RAEMDONCK DE, et al. Survival in adult lung transplantation: where are we in 2020?[J]. Curr Opin Organ Transplant, 2020, 25(3): 268-273. DOI: 10.1097/MOT.0000000000000753.
    [3] 肖漓, 解立新, 石炳毅. 肺移植免疫学相关基础与临床研究进展[J]. 器官移植, 2021, 12(6): 637-642. DOI: 10.3969/j.issn.1674-7445.2021.06.001.

    XIAO L, XIE LX, SHI BY. Progress on basic and clinical research of immunology in lung transplantation[J]. Organ Transplant, 2021, 12(6): 637-642. DOI: 10.3969/j.issn.1674-7445.2021.06.001.
    [4] HAYES D JR, CHERIKH WS, CHAMBERS DC, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: twenty-second pediatric lung and heart-lung transplantation report-2019; focus theme: donor and recipient size match[J]. J Heart Lung Transplant, 2019, 38(10): 1015-1027. DOI: 10.1016/j.healun.2019.08.003.
    [5] CHAMBERS DC, PERCH M, ZUCKERMANN A, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-eighth adult lung transplantation report - 2021; focus on recipient characteristics[J]. J Heart Lung Transplant, 2021, 40(10): 1060-1072. DOI: 10.1016/j.healun.2021.07.021.
    [6] PASQUE MK, COOPER JD, KAISER LR, et al. Improved technique for bilateral lung transplantation: rationale and initial clinical experience[J]. Ann Thorac Surg, 1990, 49(5): 785-791. DOI: 10.1016/0003-4975(90)90023-y.
    [7] LOOR G, MATTAR A, SCHAHEEN L, et al. Surgical complications of lung transplantation[J]. Thorac Surg Clin, 2022, 32(2): 197-209. DOI: 10.1016/j.thorsurg.2022.01.003.
    [8] ELGHARABLY H, JAVORSKI MJ, MCCURRY KR. Bilateral sequential lung transplantation: technical aspects[J]. J Thorac Dis, 2021, 13(11): 6564-6575. DOI: 10.21037/jtd-2021-22.
    [9] RUCKER AJ, NELLIS JR, KLAPPER JA, et al. Lung retransplantation in the modern era[J]. J Thorac Dis, 2021, 13(11): 6587-6593. DOI: 10.21037/jtd-2021-25.
    [10] COPPOLINO A, MODY GN, RINEWALT D, et al. Sternotomy for lung transplantation: a description of technique[J]. Ann Cardiothorac Surg, 2020, 9(1): 65-67. DOI: 10.21037/acs.2020.01.05.
    [11] 陈文慧, 郭丽娟, 赵丽, 等. 单中心50例肺移植临床特点分析[J/CD]. 中华移植杂志(电子版), 2020, 14(6): 349-354. DOI: 10.3877/cma.j.issn.1674-3903.2020.06.003.

    CHEN WH, GUO LJ, ZHAO L, et al. A single-center experience of 50 cases of adult lung transplantation[J/CD]. Chin J Transplant (Electr Edit), 2020, 14(6): 349-354. DOI: 10.3877/cma.j.issn.1674-3903.2020.06.003.
    [12] GIMÉNEZ-MILÀ M, VIDELA S, PALLARÉS N, et al. Impact of surgical technique and analgesia on clinical outcomes after lung transplantation: a STROBE-compliant cohort study[J]. Medicine (Baltimore), 2020, 99(46): e22427. DOI: 10.1097/MD.0000000000022427.
    [13] ZHANG J, LIU D, YUE B, et al. A retrospective study of lung transplantation in patients with lymphangioleiomyomatosis: challenges and outcomes[J]. Front Med (Lausanne), 2021, 8: 584826. DOI: 10.3389/fmed.2021.584826.
    [14] YUE B, YE S, LIU F, et al. Bilateral lung transplantation for patients with destroyed lung and asymmetric chest deformity[J]. Front Surg, 2021, 8: 680207. DOI: 10.3389/fsurg.2021.680207.
    [15] KELLER MB, MEDA R, FU S, et al. Comparison of donor-derived cell-free DNA between single versus double lung transplant recipients[J]. Am J Transplant, 2022, 22(10): 2451-2457. DOI: 10.1111/ajt.17039.
    [16] WU S, PENG G, XU C, et al. The outcome of lung transplantation for end-stage pulmonary diseases with pulmonary hypertension: a single-center experience[J]. J Thorac Dis, 2022, 14(4): 1020-1030. DOI: 10.21037/jtd-21-1738.
    [17] HADDAD O, JACOB S, PHAM A, et al. Harvesting left internal thoracic artery via clamshell incision for coronary bypass and lung transplant[J]. J Surg Case Rep, 2020, 2020(10): rjaa363. DOI: 10.1093/jscr/rjaa363.
    [18] EHRHARDT JD JR, BAROUTJIAN A, MCKENNEY M, et al. Historical observations on clamshell thoracotomy[J]. World J Surg, 2021, 45(4): 1237-1241. DOI: 10.1007/s00268-020-05913-4.
    [19] WEINGARTEN N, SCHRAUFNAGEL D, PLITT G, et al. Comparison of mechanical cardiopulmonary support strategies during lung transplantation[J]. Expert Rev Med Devices, 2020, 17(10): 1075-1093. DOI: 10.1080/17434440.2020.1841630.
    [20] RECK DOS SANTOS P, D'CUNHA J. Intraoperative support during lung transplantation[J]. J Thorac Dis, 2021, 13(11): 6576-6586. DOI: 10.21037/jtd-21-1166.
    [21] MEYERS BF, SUNDARESAN RS, GUTHRIE T, et al. Bilateral sequential lung transplantation without sternal division eliminates posttransplantation sternal complications[J]. J Thorac Cardiovasc Surg, 1999, 117(2): 358-364. DOI: 10.1016/S0022-5223(99)70434-4.
    [22] OLLAND A, REEB J, GUINARD S, et al. Clamshell closure with absorbable sternal pins in lung transplant recipients[J]. Ann Thorac Surg, 2017, 104(2): e207-e209. DOI: 10.1016/j.athoracsur.2017.04.036.
    [23] MACCHIARINI P, LADURIE FL, CERRINA J, et al. Clamshell or sternotomy for double lung or heart-lung transplantation?[J]. Eur J Cardiothorac Surg, 1999, 15(3): 333-339. DOI: 10.1016/s1010-7940(99)00009-3.
    [24] RUIZ LÓPEZ E, CEREZO MADUEÑO F, GONZÁLEZ GARCIA FJ, et al. Thoracotomy wound dehiscence after lung transplant is an effective surgical solution: a case report[J]. Transplant Proc, 2020, 52(2): 584-586. DOI: 10.1016/j.transproceed.2019.11.035.
    [25] DELL'AMORE A, CAMPISI A, CONGIU S, et al. Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension[J]. Artif Organs, 2020, 44(6): 628-637. DOI: 10.1111/aor.13628.
    [26] 陈静瑜, 郑明峰, 何毅军, 等. 不横断胸骨双侧前胸切口双肺移植[J]. 中华器官移植杂志, 2006, 27(2): 72-74. DOI: 10.3760/cma.j.issn.0254-1785.2006.02.003.

    CHEN JY, ZHENG MF, HE YJ, et al. Bilateral sequential lung transplantation through bilateral anterolateral thoracotomy without sternal division[J]. Chin J Organ Transplant, 2006, 27(2): 72-74. DOI: 10.3760/cma.j.issn.0254-1785.2006.02.003.
    [27] DÜRRLEMAN N, MASSARD G. Posterolateral thoracotomy[J]. Multimed Man Cardiothorac Surg, 2006. DOI: 10.1510/mmcts.2005.001453.
    [28] THABUT G, MAL H, CERRINA J, et al. Graft ischemic time and outcome of lung transplantation: a multicenter analysis[J]. Am J Respir Crit Care Med, 2005, 171(7): 786-791. DOI: 10.1164/rccm.200409-1248OC.
    [29] HASENAUER A, BÉDAT B, PARAPANOV R, et al. Effects of cold or warm ischemia and ex-vivo lung perfusion on the release of damage associated molecular patterns and inflammatory cytokines in experimental lung transplantation[J]. J Heart Lung Transplant, 2021, 40(9): 905-916. DOI: 10.1016/j.healun.2021.05.015.
    [30] NĘCKI M, ANTOŃCZYK R, PANDEL A, et al. Impact of cold ischemia time on frequency of airway complications among lung transplant recipients[J]. Transplant Proc, 2020, 52(7): 2160-2164. DOI: 10.1016/j.transproceed.2020.03.047.
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出版历程
  • 收稿日期:  2022-07-11
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

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