lung transplantation

For patients with irreversible progressive advanced lung disease, the life span is less than 12 to 18 months. Such as unilateral pulmonary fibrosis at the end, most suitable for unilateral lung transplantation; emphysema, bilateral pulmonary fibrosis, bronchiectasis and chronic lung suppuration are suitable for double lung transplantation. Treatment of diseases: elderly lung cancer Indication (a) receptor 1. Irreversible progressive advanced lung disease, the life span is less than 12 to 18 months. Such as unilateral pulmonary fibrosis at the end, most suitable for unilateral lung transplantation; emphysema, bilateral pulmonary fibrosis, bronchiectasis and chronic lung suppuration are suitable for double lung transplantation. 2. Age is less than 60 years old. 3. Can participate in indoor activities under oxygen inhalation. 4. No heart, brain, liver or kidney disease. 5. No history of mental illness and family history, stable mental state. 6. No immunosuppressive application contraindications. (2) Donor 1. Age is less than 55 years old. 2. No life organ diseases. 3. No malignant tumor; no diabetes. 4. The chest radiograph is normal and there is no history of chest trauma. 5. ABO blood type is consistent, lymphocyte cross-matching test is negative. 6. The chest volume is equivalent. Contraindications Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure (1) Removal of donor lungs The unilateral lung and the bilateral lung were taken out in the same way. 1. The sternal midline incision. Block the vena cava reflux. Spleen prostaglandin (prostaglandin E) 500 mg was injected from the pulmonary artery, and then the lung protective solution was reperfused and allowed to overflow from the small opening previously cut by the left atrial appendage. 2. Unilateral lung extraction: at the left atrium of the pulmonary vein opening, the left atrium wall of 0.5 mm width is preserved and cut; the pulmonary artery is cut from the bifurcation; the main bronchus is at the upper cartilage ring of the upper bronchial opening Cut off. 3. Bilateral lung extraction: the left atrium was cut open at the center between the right pulmonary vein and the coronary sinus, and the left atrial sleeve containing 4 pulmonary veins was retained; the pulmonary artery was cut at the midpoint of the pulmonary valve and the pulmonary artery bifurcation; The trachea was cut at the 2 tracheal rings on the carina. 4. Immediately after the lungs were removed, immersed in 4 ° C Collins cold protection solution. (B) the removal of the recipient lung 1. Position and incision: bilateral lung resection, take the supine position of the sternal midline incision; right lung resection, take the left lateral reclining of the right thoracic 6th ribbed incision; left lung resection, take the right lateral position left The 6th ribbed incision on the lateral side of the chest. 2. Recipient unilateral lung resection: free pulmonary artery, ligation and sever at the first branch; upper and lower pulmonary veins were ligated and cut at the left atrium; closed the main bronchus with a tracheal forceps, and at the distal end of the upper lobe The plane of the bronchial opening is cut off, and the diseased lung is completely removed. 3. Recipient bilateral lung resection: first establish extracorporeal circulation. The method of ligation and cutting of the pulmonary artery and the pulmonary vein is the same as above. The trachea was cut at 1 cm above the carina. (C) unilateral lung implantation anastomosis 1. The lungs are placed in the chest. The left atrium was anastomosed with a 3-0 Prolene line. 2. The end of the pulmonary artery was anastomosed with a 4-0 Prolene line. The last shot is not tied. 3. The main bronchus was anastomosed with a 4-0 Prolene line interrupted end. Check the anastomosis for leaks. 4. Open the atrial forceps and there is blood flowing out of the pulmonary artery anastomosis within 5 minutes. Ligation of the last needle of the pulmonary anastomosis. (4) Implantation of bilateral lungs It is carried out under cardiopulmonary bypass. 1. Anastomize the trachea with a 4-0 Prolene line interrupted end. Check the anastomosis for leaks. If necessary, the abdominal cavity is opened by the mid-abdominal incision, and a pedicled omentum is released, lifted from the anterior mediastinum to the chest cavity, and sutured to the tracheal anastomosis with the cover. 2. Stabilize the left atrium with a 3-0 Prolene line. 3. The end of the pulmonary artery was anastomosed with a 4-0 Prolene line. complication 1 infection. 2 ischemia reperfusion injury. 3 airway complications. 4 acute rejection. 5 chronic rejection.