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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
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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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