摘要
目的总结原位心脏移植受者再行外科手术的围术期处理经验,了解心脏移植术后外科疾病的特点。方法对5例原位心脏移植受者施行手术治疗,其中急性胆囊炎2例,急性阑尾炎、双侧巨乳及肺部肿瘤各1例。再次手术时患者平均年龄44.6岁(14～60岁),距心脏移植手术时间平均为16.4个月(4～37个月)。急性胆囊炎和阑尾炎患者均在急诊情况下切除病灶;双侧巨乳患者施行双侧巨乳缩小术;肺部肿瘤患者先于胸腔镜下切除肿块,经快速冰冻病理证实肿瘤为恶性后再行小切口肺癌根治性切除术。术后连续监测环孢素A(CsA)或他克莫司(FK506)血药浓度,动态调整免疫抑制剂用量;加强围手术期抗感染治疗力度。结果4例患者术后2周内康复,顺利出院;1例急性胆囊炎患者因术后发生胃潴留经内科治疗66d后康复出院。所有患者围手术期均无严重感染、出血等手术并发症,无急性排斥反应及心脏移植物功能不全发生。平均住院时间为21.3d(8～66d)。术后随访1～13个月,无手术疾病复发,亦未出现移植心脏功能不全,生活质量良好。结论心脏移植术后虽因长期服用免疫抑制剂导致抵抗力低下,但如患外科疾病仍需积极手术治疗。经充分的术前准备,患者能够耐受再次手术治疗并获良好的疗效。
Objective To summarize the surgical outcomes and clinical experience of surgical disease for patients having undergone orthotopic heart transplantation. Methods Five cardiac transplant recipients requiring surgical management clue to other surgical diseases including acute cholecystitis in 2 patients, acute appendicitis, bilateral mammary hypertrophy and lung tumor in 1 patients, respectively. The mean age of the entire group at the time of reoperation was 44.6 years （14-60 years） and the average time of operative procedures after transplant was 16.4 months （4-37 months）. Four patients were treated with triple immunosuppression, including cyclosporine A （CsA） or taerolimus, myeophenolate mofetil and eortieosteroids, respectively. One patient received double-therapy of CsA and myeophenolate mofetil with early withdrawal of eortieosteroids. All the acute eholeeystitis and appendicitis patients underwent open eholeeysteetomy and appendectomy emergently. Reduction mammaplasty was performed on the bilateral mammary hypertrophy patients. For the lung tumor patient, right upper lobeetomy and nodes excision were undertaken radically after the sample proved to be malignancy by the thoraeoseopy. Closely surveillance at concentration of CsA or FK506 was performed eontinueously in order to adjust the effective blood concentration in a steady way by which acute rejection can be avoided. The pathways which pathogen organisms invading the human body were controlled strictly as well as intension on anti-infection treatment during perioperative period. Results Four patients discharged to home within 2 weeks. Only one patient needed further treatment in Digestive Department after emergent eholeeysteetomy due to gastric retention. And she was discharged after 66 days. No acute rejections or operative complications such as severe infection or bleeding were found during the perioperative period. The average length of stay was 21.3 days （8-66 days）. During the follow-up from 1 month to 13 months, there was no relapse o
出处
《中国胸心血管外科临床杂志》
CAS
2008年第1期17-20,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
心脏移植
外科手术
预后
Cardiac transplantation
Surgery
Prognosis
