摘要
目的 观察2例肺移植术后支气管闭塞患者的临床表现,探讨行经支气管镜再开通治疗的效果。方法 肺移植术后支气管闭塞患者2例,均行支气管镜下闭塞段再开通术。术后每2~3周随访,行支气管镜检查观察支气管管腔再狭窄发生情况。结果 2例均于肺移植术后4个月复查胸部CT及支气管镜检查,例1患者示左侧支气管吻合口完全闭塞,例2示右肺上叶非吻合口远端支气管完全闭塞。2例均于支气管镜下评估闭塞段位置、黏膜纹理走向及交汇点,识别闭塞段潜在开口,高频电刀开通闭塞段支气管,经导丝引导球囊扩张,观察无局部出血、黏膜撕裂、吻合口开裂后,吸引远端管腔分泌物,再次给予球囊扩张,评估无出血、吻合口开裂等后,狭窄段管壁局部行CO冷冻治疗,评估无出血、吻合口开裂风险后退镜,结束治疗。2例术中均顺利定位闭塞段潜在开口,术后支气管闭塞段顺利开通,呼吸困难程度减轻,术后未发生咯血、支气管胸膜瘘、支气管断裂等并发症。例1患者随访期间支气管管腔反复狭窄,间断行球囊扩张等治疗。例2患者术后2个月右上叶支气管再次闭塞,局部瘢痕组织增生,支气管镜下再开通未成功,右中间支气管通畅;随访至2022年7月,患者胸闷症状减轻,可耐受日常活动,右肺上叶未见肺不张,可能存在侧支通气。结论 肺移植术后支气管闭塞患者行经支气管镜再开通治疗可开通闭塞段支气管,但闭塞段支气管可再次发生狭窄甚至闭塞。
Objective To observe the clinical manifestations of bronchial occlusion after lung transplantation in two patients and to investigate the outcome of recanalization by bronchoscopy. Methods Two patients with bronchial occlusion after lung transplantation underwent recanalization by bronchoscopy. Bronchoscopy was performed every two to three weeks after operation to observe restenosis of the bronchial lumen. Results Both patients had chest CT and bronchoscopy reviewed 4 months after lung transplantation, showing left main bronchus anastomotic occlusion in patient 1 and non-anastomotic distal bronchial occlusion in the upper lobe of the right lung in patient 2. The location of the occluded segment was evaluated. The potential opening of the occluded segment was identified by the direction of mucosal texture and the meeting point of the occluded segment under bronchoscopy in both patients. The occluded segment was recanalized by endotherm knife, and the balloon was expanded by a guide wire. After observing no local bleeding, mucosal tear, or anastomotic dehiscence, the distal lumen secretion was aspirated, and balloon dilation was given again. And after bleeding or anastomotic dehiscence was excluded, COcryotherapy was applied locally to the wall of the stenotic segment,then the bronchoscope was withdrawn to complete the treatment after excluding risk of bleeding or anastomotic dehiscence.The potential opening of the occluded segment was successfully positioned in operation,the occluded segment was opened and expiratory dyspnea was relieved.No postoperative complications such as hemoptysis,bronchopleural fistula,or bronchial rupture occurred.In patient 1,restenosis developed in the bronchial lumen during follow up survey,and balloon dilation was performed intermittently.In patient 2,the right upper lobe bronchus was occluded again 2months after bronchoscopy,with hyperplasia of scar tissue.Recanalization of occluded segment by bronchoscopy was unsuccessful,but the right middle bronchus was patent.The patients were followed up till July 2022.The chest tightness was relieved,and daily activities were tolerated.No pulmonary atelectasis was seen in the right upper lobe,with possible lateral branch ventilation.Conclusion Bronchial occlusion after lung transplantation can be recanalized by bronchoscopy,but stenosis and even occlusion might develop again in the occluded bronchus.
作者
刘峰辉
赵凯
李丰科
丁志丹
王跃斌
陈瑞英
赵高峰
欧阳松云
LIU Feng-hui;ZHAO Kai;LI Feng-ke;DING Zhi-dan;WANG Yue-bin;CHEN Rui-ying;ZHAO Gao-feng;OUYANG Song-yun(Department of Respiratory and Sleep Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Thoracic Surgery and Lung Transplantation Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)
出处
《中华实用诊断与治疗杂志》
2022年第9期870-873,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金委员会-河南省人民政府人才培养联合基金(U1804195)。
关键词
支气管闭塞
支气管消失综合征
肺移植
支气管镜
bronchial occlusion
vanishing bronchus syndrome
lung transplantation
bronchoscope
作者简介
通信作者:赵高峰,E-mail:zhaogaofeng@zzu.edu.cn;通信作者:欧阳松云,E-mail:ouyangsy@163.com。
