Objective To discuss the feasibility of the lung transplantation as an effective treatment for end-stage pulmonary diseases domestically and to compare the major issues involving the practice of lung transplantation domestically and overseas.Methods After the foundation of group of lung transplantation in May 2002, lung transplantation models of porcine were set up. From September 2002 to April 2005, in the 18 cases undergoing lung transplantation, there were subjected to single-lung transplantion (SLT, 83.3%) and 3 bilateral sequential single lung transplants without CPB (DSSLT, 16.7%). Indications for SLT (n=15) included emphysema (n=9), pulmonary fibrosis (n=3), pneumosilicosis (n=1), lymphangioleiomyomatosis (n=1) and ventricular septal defect (VSD) induced Eisenmenger's syndrome (n=1); for DSSLT (n=3) bronchiectasis (n=1) and pulmonary emphysema (n=2). Among the 15 SLTs, there were 9 cases of left SLT and 6 right SLT. Among them, 2 cases shared one same donor's lung block, one case received contralateral lung transplantation―a left donor lung implanted in the recipient’s right thorax, and one case simultaneous right SLT and VSD repair. Results In hospital mortality (HM) was 3/18 ( 16.7%). Among SLTs, early death was due to severe rejection on the 30th postoperative day in one patient and acute rejection on the 15th postoperative day in other patients, and another patient died due to pulmonary vein embolism on the 36th day. There were 3 and 2 patients with the survival time longer than 1 and 2 years respectively. The median overall survival was 10 (2 to 32) months. Conclusions Our LT program shows similar results to those reported by the International Society for Heart and Lung Transplantation for developed countries. The key of successful operation depends on the establishment of group of lung transplantation and cooperation of multi-department. Ischemic-reperfusion injury, acute-rejection and infection are the major reasons of deaths shortly after the operations.

Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.

Objective To explore the role of remote ischemic preconditioning(RIPC)in prevention of contrast -induced nephropathy(CIN)in elderly patients undergoing coronary artery angiography(CAA).Methods 106 elderly patients were enrolled in this randomized control trial.According to random number table,the patients were randomized into control group (n =53)and RIPC group(n =53).All of the patients received 1 000mL of 0.9% sodium chloride injection before CAA.The RIPC group patients underwent RIPC in their right arms with sphygmomanometer cuff infla-tion for 5 minutes prior to the CAA,three cycles were repeated.Serum creatinine was detected before and 48 hours after CAA.Results CIN was reported in 10 cases in the control group and 3 cases in the RIPC group(χ2 =4.30, P =0.04).The levels of serum creatinine were increased[(96.38 ±9.50)μmol/L vs (88.87 ±10.24)μmol/L] after CAA in the control group(t =2.28,P =0.03),and there was no difference in the RIPC group(t =1.17,P =0.24).Conclusion RIPC has a protective effect on CIN in elderly patients in our study.Since this method is harm-less and cost effective,further studies is required to popularize PIPC to our clinical practice for prevention of CIN.

Objective To discuss the benefits of extracorporeal membrane oxygenation (ECMO) applied in the patients with primary or secondary pulmonary hypertension during the operation of lung transplantation. Methods Thirty cases of end stage lung disease subject to primary or secondary pulmonary hypertension received lung transplantation supported with ECMO between Nov. 2005 and July 2009. The single lung transplantation was performed on 18 cases and bilateral sequential single lung transplantation on 12 cases. ECMO was used in 2 patients as a bridge to the lung transplantation to maintain 19 and 6 days respectively, and ECMO support was given during lung transplantation. ECMO was removed after the transplantation if the oxygenation and hemodynamics were stable, otherwise, ECMO was applied continuously until the situation improved. Results All the operations of these patients were accomplished successfully and the ECMO was removed in 27 patients after the operation immediately. The average time with ECMO was 6. 81 + 0. 95 h, and pulmonary artery systolic pressure after lung transplantation was 31.67 + 8. 42 mmHg. The ECMO was continuously used after lung transplantation in three patients until the hemodynamics was stable, and ECMO in 2 of them was removed at 36th h and 6th day respectively after the operation, and one,receiving postoperative ECMO for 5 days, died of acute renal failure 2 weeks after the operation.Conclusion ECMO can replace CPB safely and effectively in lung transplantations for primary or secondary pulmonary hypertension patients. As a respiratory and circulatory support it can control pulmonary hypertension during operative period and can decrease the complications of lung transplantation.

Objective To observe the effects of extracorporeal membrane oxygenation (ECMO) on coagulation during lung trangplantation.Method Forty cases of end stage lung diseases received bilateral sequential single lung transplantation during July 2007 and Mar.2012.The patients were divided into two groups in terms of ECMO.ECMO was applied before lung transplantation if needed.The amount of bleeding during surgery was recorded.The venous blood samples were collected during and after operation for the measurements of the following parameters:activated whole blood clot time (ACT),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT) and plasma fibrinogen (Fg).Result The coagulation and the amount of bleeding showed no significant difference between the two groups.Wound infection occurred in 2 patients where the ECMO tube was inserted and femoral arterial thrombosis in one patient.All of the three patients were cured and discharged.Conclusion ECMO didn't cause excessive bleeding or coagulation dysfunction during lung transplantation,yet it maybe increase the occurrence of local thrombosis.

Objective To observe the therapeutic effects of lung transplantation for diffuse pulmonary disease. Methods From September 2002 to April 2009, lung transplantation was performed on 72 cases in our hospital. Thirty-seven cases of these recipients were suffered from diffuse pulmonary disease, including idiopathic pulmonary fibrosis (30/37), pneumosilicosis (4/37), vascular leiomyoma (2/37) ,diffuse panbronchiolitis (1/37),30 males and 7 females with age ranging from 22 to 73 years old (mean 52.9 ± 13.2). All the patients received pulmonary function test and echocardiography (ECHO) to test the pulmonary artery systolic pressure before transplantation and artery blood gas to calculate the oxygenation index (PaO2/FiO2 ). Results The systolic pulmonary artery pressure (Ppa,syst) was monitored by Swan-Gans catheterization one week post-transplant, and decreased significantly from 54. 30 ± 17. 41 to 41.52 ± 9. 36 mm Hg (P＜0. 05). Simultaneously, oxygenation index was improved from 185. 89 ± 77. 25 to 392. 12 ± 98. 23 (P＜0. 05). The pulmonary function was also improved significanzly one month post-operation. The volume in the first second was improved from (1.33 ± 0. 64) to (1.81 ± 0. 57) L, and the diffusion capacity of carbonmonoxide was increased from (2. 87 ± 1.26) to (4. 22 ± 2. 05) L. Conclusion Lung transplantation is feasible and efficient to deal with diffuse pulmonary disease.

Objective To investigate the influence of perioperative administration of Ambroxol on pulmonary function, postoperative complications, postoperative hospital-stay and cost in elderly lung cancer patients after thoracic lobectomy surgery.Methods One hundred and forty consecutive elderly patients who underwent thoracic lobectomy surgery for lung cancer were randomly assigned into 2 groups: control group (n=70) and Ambroxol group (n=70).In control group, subjects were given the standardized treatment.In the Ambroxol group, patients were given the standardized treatment plus Ambroxol (90 mg/q, 8 h/d) from the day of operation to postoperative 5 days.The preoperative general information, intraoperative conditions, pulmonary function tests, arterial blood gases, incidence of perioperative morbidity, duration of ICU stay, length and costs of postoperative hospital-stay were collected and compared between the 2 groups.Results The 2 groups were well matched for demographics and operative variables.The forced expiratory volume in 1 second (FEV1),the forced vital capacity (FVC), peak expiratory flow rate (PEF) and arterial oxygen pressure were reduced in the 2 groups after operation as compared with before treatment, while the decreases of the above indexes were more significant in the control group than in the Ambroxol group (P＜0.05).Compared with the control group, the postoperative pulmonary complications declined, oxygenation index improved, the postoperative ICU occupancy rate and the length and costs of postoperative hospital-stay were decreased in the ambroxol group (all P＜ 0.05).Conclusions Perioperative administration of Ambroxol could reduce the incidence of pulmonary complications, improve the lung function, decrease the total hospitalization cost, shorten the length of hospital-stay, promote a rapid recovery after surgery, which is worthy of clinical application.

Objective To estimate the indications, operative technique, perioperative treatment, postoperative complications and the outcome of lung transplantation (LTx) for end-stage pulmonary diseases. Methods The clinical data of 100 patients with end-stage lung diseases receiving LTx in our hospital were retrospectively analyzed. The main indications for LTx were as follows:idiopatic pulmonary fibrosis (IPF, 47/100), chronic obstructive pulmonary disease (COPD, 33/100),silicosis (5/100 ), bronchiectasis ( 5/100 ), Eisenmenger syndrome (4/100 ), secondary lung tuberculosis (2/100), idiopathic pulmonary hypertension ( 2/100 ), lung lymphangioleiomyomatosis ( 1/100), primary alveolar cell carcicoma (1/100). There were 72 patients receiving single LTx and 28 patients receiving bilateral LTx. Sixty-one patients received lTx under circulation support, including 5 cases of cardiopulmonary bypass (CPB) support and 56 cases of extracorporeal membrane oxygenation (ECMO) support. All the patients were followed up when they discharged from our hospital. The issues including postoperative complications and prognosis were observed. Results The perioperative survival rate was 82. 0 % (82/100). There were 18 deaths in early stage (30 days) after LTx: 10 due to pulmonary infection, 6 due to primary graft dysfunction (PGD), 1 due to acute rejection (AR) and 1 due to pulmonary infarction. The common complications included lung infection (11 cases), PGD (10 cases), AR (3 cases), tracheostenosis (10 cases), stoma fistula (3 cases),hemorrhage (3 cases), pulmonary embolism (3 cases), pulmonary artery stenosis (one case) and thrombus in the deep veins of lower limb (one case). During long-term follow-up period, 15 patients developed obliterative bronchiolitis, and one patient suffered from lung cancer in his contralateral native lung. The 1-, 2-, 3- and 5-year survival rate after LTx was 73.3 %, 61.6 %, 53.5 % and 40. 7 % respectively. Conclusion LTx is an effective therapy for various end-stage pulmonary diseases. Perioperative mortality is especially high in patients undergoing LTx. Consummate perioperative management is the key to increase survival rate.

Objective To analyze the diagnosis and treatment of airway stenosis in a consecutive series of bronchial anastomosis after lung transplantation in our center.Methods We performed a retrospective study on 100 cases of lung transplants in our center from September 2002 to December 2010.Seventy-two cases were subjected to single lung transplants (SLT), and twenty-eight to bilateral sequential single lung transplantation (BSSLT). There were totally 128 bronchial anastomoses.All recipients received long-term follow-up to monitor the lung function.Lung CT and fibrobronchoscopic examinations were done when necessary. Results Twenty-five cases with 37 bronchial anatomoses were died.A total of 12 airway stenosis occurred in 10 cases (12/128,9.4 ％).Four cases underwent telescopic anastomosis and 6 cases underwent end-to-end anastamosis.Mean diagnosis time was 60.1 35.6 days post-operation (ranging from 15-120 days,median 59 days).There were 8 cases of unilateral airway stenosis (3 on the left,and 5 on the right) and 2 cases of bilateral airway stenosis.The number of simple airway stenosis was 3,that of exophytie granulation tissue was 8,and that of bronchus intermedius stenosis was 1.Culture of bacteria by fibrobronchoscopy with protected specimen brush revealed:3 strains of Pseudomonas aeruginosa,2 strains of Klebsiella pneumoniae,2 strains of Aspergillus,1 strain of Escherichia Coli. 10 cases were treated with fiberoptic bronchoscopic balloon dilation:5 cases with high-frequency electrotome,4 cases with stent placement,and 1 case with argon plasma coagulation (APC).Seven cases were cured or improved and 3 cases died.Conclusion Airway stenosis after lung transplantation remains a major problem.The fiberoptic bronchoscopic procedure is the gold standard to diagnose. The preferred treatment is fiberoptic bronchoscopic balloon under expansion,and other approaches include high-frequency electrotome,APC and stem placement,etc.

Objective To evaluate the effects of ambroxol on prevention of bronchopulmonary complications after thoracotomy in patients with chronic obstructive pulmonary disease(COPD).MethodsTotal 161 elderly patients aged ≥70 years with COPD undergoing thoracotomy were randomly allocated to two groups:ambroxol group (300 mg/d,6 d) and placebo group as control.Pulmonary complications were evaluated by clinical symptoms,radiographic changes,and blood gas analysis. Results The incidence rates of atelectasis were 8.6％ in ambroxol group and 28.8％ in placebo group,respectively.The PaO2 values after surgery in ambroxol group decreased more than in placebo group (P＜0.05) compared with the preoperative values.Side effects were not found in all patients.Conclusions Ambroxol should be considered as an alternative pharmacologic approach for the prevention of post-thoracotomy pulmonary complications in the elderly patients with COPD.