肺移植国内外进展课件

肺移植国内外进展肺移植国内外进展LungTransplantHistoryFirstexperimentaloperation:1950-54Metras,HardinFirsthumanoperation:1963HardyRecipient:58-yr-oldman,emphysemaDonor:MI,shock-ERleftsinglelungTxBackground：LungTransplantationLung Transplant HistoryFirst eBackground：LungTransplantationBackground：Lung Transplantati1stSuccess1983-TorontoLungTransplantGroup58yroldmale,IPFSurvived7yearsDiedofkidneyfailurecausedbyanti-rejectionmedicationBackground：LungTransplantation1st Success1983-Toronto LungEnBlocDoubleLungDark(1986)experimentaltechnique(canine)1986Pattersonetal.-firstsuccessfulenblocdoublelungtransplant(Alivetoday)DonorairwayischemiastillaproblemBackground：LungTransplantationEn Bloc Double LungDark(1986)SequentialDoubleLungPasqueetal.WashU.Bilateralsequentiallungtransplantationemergedin1989MayavoidCPB.NoneedforcardioplegiaReducedbronchialanastomoticproblemsBackground：LungTransplantationSequential Double Lung Pasque Living-donorlobarlungtransplantationwasintroducedbyStarnesandcolleaguesin1991Recipient(son)PPHDonor(mother)rightlowerlobeBackground：LungTransplantationLiving-donor lobar lung transpTheRegistryoftheInternationalSocietyforHeartandLungTransplantation:Twenty-seventhofficialadultlungandheart-lungtransplantreportISHLT2010Background：LungTransplantationThe Registry of the InternatioNUMBEROFLUNGTRANSPLANTSREPORTEDBYYEARANDPROCEDURETYPEISHLTNOTE:ThisfigureincludesonlythelungtransplantsthatarereportedtotheISHLTTransplantRegistry.Assuch,thisshouldnotbeconstruedasrepresentingchangesinthenumberoflungtransplantsperformedworldwide.2010NUMBER OF LUNG TRANSPLANTS REPADULTLUNGTRANSPLANTATIONKaplan-MeierSurvival(Transplants:January1994-June2008)ISHLT2010ADULT LUNG TRANSPLANTATIONKapADULTLUNGTRANSPLANTATION:Indications(1/1995-6/2009)ISHLT2010ADULT LUNG TRANSPLANTATION:InADULTLUNGTRANSPLANTATIONProcedureTypewithinIndication,byYearISHLT2010ADULT LUNG TRANSPLANTATIONProADULTLUNGTRANSPLANTATIONKaplan-Meiersurvivalbydiagnosis(Transplants:January1988June2008)ISHLT2010ADULT LUNG TRANSPLANTATIONKapADULTLUNGTRANSPLANTRECIPIENTS:CauseOfDeath(Deaths:January1992-June2009)ISHLT2010ADULT LUNG TRANSPLANT RECIPIENDonorLungFlushingtoremoveblood,preservationQuestions:Tm,Time,solutioninflation?TransplantationQuestion:HowtodotheoperationReperfusionQuestions:Rate,pressure,ventilation,etcTransportfromAtoBDonor LungFlushing to removeTrBarrierstoSuccessshortageofdonorswaitinglistmortalityPGDacuterejectionBOS.Barriers to Success肺移植国内外进展课件NovaLungBridgetoLungTransplantationNovaLungBridge to Lung Transp肺移植国内外进展课件NovaLungNovaLung肺移植国内外进展课件DeceasedDonorsCurrentlargest,bestsourceofdonorlungsWehaveNOTmaximizedutilizationNeedtoimproveutilization:ManagedonorsbetterDevelopbetterstrategiestopredictposttransplantlungfunctionStrategiestoassesslungs(ex-vivo)Strategiesto“repair”donorlungsDeceased DonorsCurrent largeDonorLungPhysiologicAssessmentExcellentBiologicAssessmentExcellentTRANSPLANTFailsEx-vivoAssessmentandTreatmentDonor LungPhysiologic AssessmeDONORLUNGPhysiologicAssessmentExcellentBiologicAssessmentExcellentTRANSPLANTFailsEx-vivoAssessmentandTreatmentFailsGeneTherapy,OtherRepairStrategiesReassessFailsNoTransplantDONOR LUNGPhysiologic AssessmeLungTransplantationinChinaFirststage1978Dr.XingYu-ling,firstSLTxforTBinChina,died1995Dr.ChenYu-pingSLTxforIPFsurvived1998Dr.ChenYu-pingBLTxforPPHwithCPBurvivedLung Transplantation in China 1978Dr.XingYu-lingfirstSLTxforTBinChina,1978 Dr.Xing Yu-ling Dr.ChenYu-ping1995-2-23,SLTxforIPFsurvived5y10m1998-1-20,BLTxforPPHwithCPB,survived4y3mBackground：LungTransplantationDr.Chen Yu-ping Background：LFrom1994to1998,about20caseswereperformed,only2patientssurvived.TheLTxstopedinChinafrom1998-Sep.2002becauseoflowsurvivalrate.From 1994 to 1998,about 20 cSecondstageSincetheSLTxforCOPDwasperformedbyWuxiGrouponSep.2002,remarkableprogresshavebeachievedinChina.Second stage 移植器官种类首例（年）至07年累计例数至今累计例数尸体肾移植196980488105000（预计）活体肾移植197314952500（预计）尸体肝移植19771273020251活体肝移植19951391569心脏移植19785341100（预计）肺移植1979128260（预计）小肠移植19941540（预计）器官移植学会登记处各种器官移植统计*数据主要来源于各移植数据中心移植器官种类首例（年）至07年累计例数至今累计例数尸体肾移植肺移植国内外进展课件肺移植国内外进展课件NumberoflungtransplantsinChina(1978-2010)Number of lung transplants in 肺移植国内外进展课件肺移植国内外进展课件本中心本中心Result1，2，3,5yearsurviverateis73.3%,61.6%,53.5%,40.7%.Result1，2，3,5 year survive rInsisionconsiderationBilateralanterolateralthoracotomiesClamshellincision(trans-sternalBilateralthoracotomyincision)AnteromusclesparingthoractomyMinimallyinvasivetechniquewithVATSInsision considerationBilateraInsisionconsiderationInsision considerationInsisionconsiderationInsision considerationInsisionconsiderationInsision considerationOperativetechniqueBronchialanastomosisArterialanastomosisLeftatriumanastomosisSizediscrepanciesUnusualcircumstanceOperative technique Bronchial OperativetechniqueOperative technique肺移植国内外进展课件OperativetechniqueOperative techniquePulmonaryArteryAnastomosisOperativetechniquePulmonary Artery AnastomosisOp肺移植国内外进展课件LeftAtrialAnastomosisLeft Atrial Anastomosis肺移植国内外进展课件术后病理术后病理BSLTx1st,March20055.Ventilatordependentrecipient术后病理 术后病理 BSLTx 1st,March 20Preoperativechestroentgenogramofa49-yearmanwithCOPD.1.68cm,46kg,BMI73%Preoperationdependedonventilatorfor107days.Preoperative chest roentgenogr肺移植国内外进展课件肺移植国内外进展课件BLTwithoutsternaldivisionBLT without sternal division肺移植国内外进展课件肺移植国内外进展课件肺移植国内外进展课件12.Male,46y,BACBLTx12.Male,46y,BAC BLTx单肺移植同期心内缺损修补治疗艾森曼格综合征男性，16岁，先天性心脏病室间隔缺损心内直视探查术后，术前肺动脉压力110/60mmHg（Pp/Ps1.0），静息紫绀4年，活动耐力明显减低，于2004年10月22日在全麻低温体外循环下行室缺修补、同期右侧单肺移植术。术中体外循环时间244分钟，供肺冷缺血时间6小时，术后FK506、MMF、激素三联免疫抑制治疗。单肺移植同期心内缺损修补治疗艾森曼格综合征男性，16岁，先天肺移植国内外进展课件肺移植国内外进展课件n术后三天内移植肺出现中等度再植反应性肺水肿，术后7天气管切开，12天撤离呼吸机；术后14天出现急性排斥1次，治疗后缓解。术后肺动脉压力53/39mmHg（Pp/Ps0.57）。术后三天内移植肺出现中等度再植反应性肺水肿，术后7天气管切开术后30天胸片及胸部CT显示右移植肺清晰，肺通气血流灌注扫描示右侧移植肺血流占90%，UCG示左室内径较术前缩小17%，室缺修补完整无残余分流，术后活动耐力明显改善，62天出院。术后随访已有5近年，生活质量良好。术后30天胸片及胸部CT显示右移植肺清晰，肺通气血流灌注扫描16F，PPH,BLTwithECMO16 F，PPH,BLT with ECMO肺移植国内外进展课件肺移植国内外进展课件术前前术后后左室舒左室舒张末内径末内径*23 mm47 mm右室舒右室舒张末内径末内径*54.7 mm28 mm左房内径左房内径*21 mm34 mm主主动脉根部内径脉根部内径*24 mm25 mm主肺主肺动脉内径脉内径44.5 mm22 mm左肺左肺动脉内径脉内径30.9 mm14 mm右肺右肺动脉内径脉内径26.2 mm14 mm肺肺动脉收脉收缩压159.4 mmHg三尖瓣和肺三尖瓣和肺动脉瓣无返流脉瓣无返流平均肺平均肺动脉脉压92.4 mmHg三尖瓣和肺三尖瓣和肺动脉瓣无返流脉瓣无返流左室射血分数左室射血分数82%69%右室射血分数右室射血分数19%62%每搏每搏输出量出量19.7 ml63 ml移植前后心超结果比较（术前及术后2.5月）术前术后左室舒张末内径*23 mm47 mm右室舒张末内径*http:/ 病毒及乙肝均为阴性。三位供体均同时捐献心、肺、肝、肾和角膜等多个器官。供体二男性27岁脑外伤12天310供体三男性31岁脑外伤6天420供体资料资料与方法性别年龄诊断机械通气氧合指数其他供体一女性39岁脑资料与方法供体资料资料与方法供 体 资 料家属与脑死亡供家属与脑死亡供体告别体告别供体肺手术方法资料与方法家属与脑死亡供体告别供体肺手术方法资料与方法供体获取团队在术供体获取团队在术前祷告前祷告供体肺手术方法资料与方法供体获取团队在术前祷告供体肺手术方法资料与方法国际标准化脑死亡供肺的获取及应用国际标准化脑死亡供肺的获取及应用性别年龄性别年龄诊断诊断其他其他受体一男性32岁支扩伴感染、肺心病、呼衰感染已控制，无发热、咯血，需间断吸氧受体二男性34岁矽肺终末期、肺动脉高压右心功能不全、呼衰长期咳嗽、气喘，术前已卧床吸氧治疗受体三男性61岁IPF、肺动脉高压右心功能不全、呼衰活动后气喘明显，需卧床吸氧受体资料国际标准化脑死亡供肺的获取及应用性别年龄诊断其他受体一男性3TransplantforlatestageofPneumosilicosisTransplant for late stage of P肺移植国内外进展课件肺移植国内外进展课件肺移植国内外进展课件主办国家级继续教育项目5项(2004-2010年)全国第一至第五届心肺移植会议主办国家级继续教育项目5项THANKS