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肺移植后气道并发症

Authors
Marcelo Cypel, MD, MSc
Tom Waddell, MD, MSc, PhD, FRCS, FACS
Shaf Keshavjee, MD, MSc, FRCSC, FACS
Section Editor
Elbert P Trulock, MD
Deputy Editor
Helen Hollingsworth, MD
Translators
杨丽, 主任医师，副教授

引言

在肺移植期间，通常在供者肺支气管与受者肺支气管之间进行气道吻合。气道吻合口历来是最容易发生肺移植手术并发症的位置。气道吻合口并发症包括：局灶性感染、支气管坏死和裂开、肉芽组织形成过度、气管支气管软化、狭窄和瘘管形成。

本文将总结肺移植后气道吻合口并发症的发生机制、诊断、治疗和预防。其他气道并发症(如，细菌性和病毒性气管支气管炎、闭塞性细支气管炎以及肺移植相关的非感染问题)将单独讨论。 (参见“肺移植术后的细菌感染”和“慢性肺移植排斥反应：闭塞性细支气管炎”和“肺移植后的非感染性并发症”)

类型和定义

肺移植后气道吻合口并发症包括通常在术后1个月内发生的早期并发症(如，吻合口感染、坏死或裂开)，以及更晚发生的晚期并发症[如，肉芽组织形成过度、支气管软化、气道狭窄、支气管胸膜瘘(bronchopleural fistula, BPF)、支气管纵隔瘘或支气管血管瘘](表 1)[1]。

移植后最初2-3周时行支气管镜检查通常可以观察到吻合口处局限性的黏膜坏死和脱落。如果无需干预即能愈合良好，那么这种轻微黏膜改变通常不考虑为“气道并发症”。当需要干预(如，清创术、扩张术或支架植入等)时，则考虑为严重并发症。

发病率和影响

有报道称气道吻合口并发症的发生率为2%-33%，但在大多数医疗中心为7%-18%[1-3]在一项纳入232例肺移植的回顾性病例系列研究中，发生了57例气道并发症；大多数发生在移植后第1年[2]。

                        

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Literature review current through: 2017-07 . | This topic last updated: 2016-04-29.
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