Experimental Study Of Autologous Single Lung Transplantation And Changes Of Postoperative Coagulopathy In Dogs

Since1963James Hardy Mississippi University first reported human lungtransplantation, so that the treatment of advanced lung parenchymal diseasepossible. Then clinicians are carrying out a global study of lungtransplantation, found the negative effects of high-dose steroid therapy forlung transplantation, but also invented the omental pedicle covering donorischemic anastomotic approach reduces bronchial anastomotic fistula. Afterthose50years of worldwide clinical unremitting efforts to develop lungtransplantation has greatly improved over the previous lung transplant surgerytechniques for lung preservation, reperfusion lung transplant rejection,perioperative care have surrounded progress to a large extent. But comparedwith other organ transplant, lung transplant is significantly lagging behind.Our lung transplant late start, its progress has been slow. Professor ofchildbearing age zinc implemented two cases equal to1979lung transplants,lung transplants to fill gaps in our country, but failed. For end-stage lungdisease, lung transplantation is the only effective treatment, because of itsimportance, has become a major issue in the new period of thoracic surgery tobe studied. The experiment was conducted animal studies dogs single lungtransplantation of autologous, autologous lung transplant carried out to lay thefoundation for some lung cancer patients.Purpose: experimental study on dogs pulmonary autograft single surgicaltechnique and preoperative and postoperative coagulation function changesobserved lung transplants familiar with and master the technical and operativecooperation, particularly in vascular and tracheal anastomosis, explore hybridchanges in the canine lung transplantation before coagulation function aftersurgery for lung transplantation of autologous carry prepare.Methods: dogs8(male or female), in good health, strong body, similar in size, weight15kg-17kg, respectively numbered1,2,3,4,5,6,7,8dogs allunderwent right pneumonectomy autograft. Standard surgical and ancillaryequipment, surgical equipment and materials necessary for self-lungpreservation solution and certain drugs. After the success of anesthesia, leftlateral position, the dog limbs fixed on the operating table, right chest routinedisinfection, sterile surgical towels, single. Layers of the chest wall incisioninto the chest, under the pulmonary ligament free, open pericardium, freeupper right, lower pulmonary vein and right pulmonary artery and right mainbronchus, line after systemic heparin, high frequency ventilation anesthesiamachine to make the right lung in an expanded state, Then quickly closed withatraumatic vascular clamp after intermittent right upper and lower pulmonaryvein and right pulmonary artery and right main bronchus, quickly cut a rightpneumonectomy placed at4℃LPD solution sterile box (which put instained box), the infusion catheter into the right pulmonary artery stump, andthe other end connected to4℃LPD whole lung lavage fluid lines and rightuntil the lung surface was white and the upper and lower ends of thepulmonary venous outflow colorless perfusion fluid so far. Perfusion processis completed within5minutes. Retention time of30minutes. Trim excesstissue, trimming pulmonary artery and vein and bronchial retain sufficientlength of the vessel wall. After the pruning is complete, right pneumonectomyplaced in the chest, placed in4℃saline to prevent excessive heating of theright lung. First stitched upper and lower pulmonary veins and knotted, thensuture the pulmonary artery, to not tie slightly loosened placed in the rightpulmonary artery stump noninvasive vascular clamp, so that a small amount ofblood reflux, then continuous suture right main bronchus. Bronchialanastomosis is completed, the open lower pulmonary vein noninvasivevascular clamp, not knotted stitches visible pulmonary perfusion liquidmixture and a small amount of blood flowing bubbles, not to be mixed withthe liquid effluent perfusion fluid and lung transplant in color from white topink when tightening the suture and tie. None of bronchial anastomotic leakcheck, arterial and venous anastomosis and no active bleeding chest, accurate inventory of surgical instruments and dressings, indwelling chest tube suturedchest wall layers. After waking pull out until their drainage tube, the end ofsurgery. Were transplanted after1hour,2hours,4hours via central venouscatheter for blood, blood coagulation and D-dimer measurement. The mainindicators are: prothrombin time, fibrinogen, D-dimer and fibrin degradationproducts.Results: All eight cases of dogs were successfully completed rightpneumonectomy autologous transplantation. After completion of the bronchialanastomosis anastomotic leak-free, no Louxue arteriovenous anastomosis.Preoperative and postoperative prothrombin time was1h,2h,4h prothrombintime compared to P<0.05, the difference was statistically significant,indicating that after the prothrombin time shortened. Description preoperativeand postoperative fibrinogen were1h,2h,4h comparing the measureddecrease in fibrinogen levels, P values were less than0.05, indicating that thedifferences were statistically significant. D-dimer compared preoperative andpostoperative1h, the difference was not statistically significant (P greater than0.05). After2h,4h measured D-dimer levels of D-dimer levels higher thanbefore surgery (P<0.05). Preoperative fibrin degradation products respectivelyafter1h,2h difference was not statistically significant (P greater than0.05),after4h fibrin degradation product and comparing levels before surgeryincreased (P <0.05).Conclusions: The initial grasp dogs autologous lung transplantationsurgical technique, postoperative1h,2h,4h shortened prothrombin time,fibrinogen levels decreased after2h,4h, and blood levels of D-dimer after4hfibrin degradation products increased compared with preoperative levels.