脳死片肺移植後の吻合部狭窄に対するステント挿入時の吻合部裂傷と致死的出血から救命できた1例  [in Japanese] Recovery from Fatal Bleeding and Laceration of Bronchial Anastomosis During Airway Stent Insertion After a Single Lung Transplantation  [in Japanese]

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Abstract

背景.肺移植後の気道狭窄は重篤な合併症の1つである.治療としてバルーン拡張術や気道ステント挿入術などが施行されるが,その手技自体にも危険性を伴う.症例. 36歳女性,肺リンパ脈管筋腫症にて脳死左片肺移植術を施行.術後気管支吻合部へのアスペルギルスの定着や緑膿菌性肺炎を繰り返し,左主気管支の吻合部狭窄が進行したためバルーン拡張術を施行. 2度目のバルーン拡張時に換気不全となり,経皮的心肺補助装置が挿入された.状態安定後の気道ステント挿入時に,吻合部に裂傷を来し出血した.出血コントロールは気管支ブロッカーによる圧迫,さらに経皮的心肺補助装置の抗凝固薬を中止し,頻回の気管支鏡による血腫除去で左肺の含気改善を得た.状態の改善を待って,後日左気管支吻合部に安全にステント挿入ができた.結論.気道ステント挿入時の致死的な出血を経験した.緊急時は抗凝固薬を用いない補助循環下の全身管理も許容され得る.

Background. Bronchial stenosis after lung transplantation is significant morbidity factor. Airway ballooning and stent insertion for the bronchial stenosis has a well-established treatment. However, its procedure is sometimes risky. Case. A 36-year-old woman underwent left single lung transplantation for lymphangioleiomyomatosis. During her clinical course, she developed repeated Pseudomonas aeruginosa pneumonia in the graft lung and also Aspergillus adhesion at the site of bronchial anastomois. Thereafter left bronchial stenosis gradually occurred and balloon dilatation was performed. Sudden deterioration of her vital signs was seen during second balloon dilatation and percutaneous cardiopulmonary support was initiated. The insertion of an airway stent was attempted to the left bronchial anastomosis, but sudden bleeding from the anastomotic site occurred due to laceration. Bronchial blocker tube oppression of left bronchus, frequent blood suction by bronchoscope, and maintenance of percutaneous cardiopulmonary assist and without anti-coagulation successfully recovered the graft lung. Later, an airway stent was successfully inserted. Conclusion. We experienced potentially lethal bleeding during airway stent insertion. Percutaneous cardiopulmonary support with free anti-coagulation management sometimes can be effective.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 35(1), 19-24, 2013

    The Japan Society for Respiratory Endoscopy

References:  10

Codes

  • NII Article ID (NAID)
    110009594306
  • NII NACSIS-CAT ID (NCID)
    AN00357687
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    0287-2137
  • Data Source
    CJP  NII-ELS  J-STAGE 
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