Analysis of curative effect of pulmonary lobectomy on atelectasis after lung transplantation
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摘要:
目的 探讨肺叶切除术治疗肺移植术后并发肺叶不张的疗效。 方 法 回顾性分析2013年7月实施肺移植术后并发肺不张两例患者的临床资料。1例为囊性纤维化双肺移植后右中上肺重症感染并肺不张,1例为支气管扩张、两肺肺气肿双肺移植后右肺中下叶肺不张。肺切除术前两例患者存在不同程度的肺部感染。两例患者分别进行右移植肺中叶切除术和右移植肺中下叶切除术。 结果 两例患者肺叶切除术后感染情况得到有效控制,康复出院。 结论 肺移植术后因严重肺部感染、支气管狭窄导致肺叶不张时,行肺叶切除术、切除病变部位能有效地控制此术后并发症。 Abstract:Objective To investigate the curative effect of pulmonary lobectomy on lobe atelectasis after lung transplantation. Method Clinical data of two patients with lobe atelectasis after lung transplantation were retrospectively analyzed in July 2013. One case developed severe infection of right middle lobe and lobe atelectasis after double lung transplantation for cystic fibrosis. The other case developed lobe atelectasis of right middle and lower lobe after double lung transplantation for bronchiectasis and pneumonectasis. Before pulmonary lobectomy, both of them suffered from pulmonary infection. Two cases underwent pulmonary lobectomy of middle lobe or middle and lower lobe of right transplant lung respectively. Result Pulmonary infection was controlled in two cases after pulmonary lobectomy. They were discharged from the hospital and had good quality of life. Conclusion Pulmonary lobectomy can be performed aggressively for pulmonary atelectasis after lung transplantation due to severe lung infection or bronchostenosis. Removal of diseased region can control the postoperative complication effectively. -
Key words:
- Lung transplantation /
- Postoperative complication /
- Infection /
- Pulmonary atelectasis /
- Pneumonectomy
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图 1 例1肺移植患者肺叶切除前后的胸部计算机体层摄影术图像
注：A图为移植前CT图像，可见双肺弥漫多个大小不等扩张支气管影及结节状高密度影，考虑囊性纤维化、先天性支气管扩张；B图为移植后第5日CT图像，可见肺移植术后改变，右肺见大片模糊影，以右中肺为甚，右肺中叶支气管显示不清，考虑为移植术后急性排斥反应期表现；C图为肺叶切除术前CT图像，可见右中肺野呈片状致密影，内见蜂窝状透亮影，右中肺支气管开口狭窄，远段支气管扩张、僵直，考虑右中肺感染伴实变、囊样变、支气管扩张；D图为肺叶切除术后第18日CT图像，可见肺移植术后改变，右肺感染情况较前明显好转
Figure 1. Computed tomography images of the chest of the first lung transplant patient before and after lung lobectomy
图 2 例2肺移植患者肺叶切除前后的胸部计算机体层摄影术图像
注：A图为移植前CT图像，可见双肺多发支气管扩张伴感染，双肺肺气肿，多发肺大疱，双肺间质性改变；B图为移植后第41日CT图像，可见双肺移植术后改变，肺野清晰；C图为肺叶切除术前CT图像，可见双肺少许索条影，右侧胸腔积液伴右下肺膨胀不全；D图为肺叶切除术后第8日CT图像，可见右下肺术后改变，右上肺叶肺纹理正常，右侧胸腔内水样密度影
Figure 2. Computed tomography images of the chest of the second lung transplant patient before and after lung lobectomy
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