Implante lobar autólogo pós pneumonectomia: modelo experimental em cães
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Data
2005-08-01
Autores
Nagao, Rincan Katsuhilo [UNESP]
Cataneo, Antonio José Maria [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Resumo
OBJETIVO: Estudar no implante lobar autólogo a eficiência da anastomose brônquica simples, a perfusão pulmonar e as complicações devido a desproporção doador/receptor. MÉTODOS: Estudou-se 15 cães submetidos à pneumonectomia esquerda, e reimplante do lobo caudal. Estudou-se a perfusão pulmonar e a anastomose brônquica, respectivamente, por cintilografia e por broncografia. O sacrifício ocorreu aproximadamente 200 dias após a cirurgia para o estudo das anastomoses e medidas de volumes e pesos pulmonares. RESULTADOS: Quatro cães foram a óbito, um por deiscência precoce de anastomose brônquica, 1 com infecção e outros 2 por infarto pulmonar devido a oclusão da veia pulmonar no local da anastomose. A perfusão relativa do pulmão direito e esquerdo foram em média respectivamente 72,7% e 27,3%. A broncografia não mostrou nem estenose nem outras alterações na anastomose brônquica. No momento do sacrifício o lobo caudal ocupava totalmente a cavidade pleural sem que houvesse evidentes desvios do mediastino. CONCLUSÕES: O estudo mostrou que a sutura brônquica término-terminal desprotegida não levou a complicações anastomóticas. Não houve complicações pelo fato do lobo implantado ter ocupado somente metade da cavidade pleural. As complicações mais importantes foram o infarto pulmonar e deiscência total da parede torácica. Tanto a broncografia como a cintilografia se mostraram eficientes respectivamente, para o estudo da anastomose brônquica e da perfusão relativa do pulmão funcionante in vivo.
PURPOSE: To study the bronchial and vascular anastomosis in the autologus lobar lung implant and show if exist complications in transplants occuping only half of pleural cavity. METHODS: We studied 15 male from 8 to 14kg. After pneumonectomy in the left chest wall we replaced the caudal lobe. In the late post operative we made bronchography and perfusion's scintigraphy and analysed the lungs after sacrified the animal. RESULTS: Four dogs died, one by early dehiscence of bronchial anastomosis, one by infection, and two by lung infarct after occlusion of lung vein in place of anastomosis. The relative perfusion of right and left lung were 72,7% and 27,3% respectively. The bronchography didn't show stenosis nor other alterations in bronchial anastomosis. After opened the thorax we saw that caudal lobe there was filled all pleural cavity without shift of the mediastinum. CONCLUSIONS: The study showed that the end to end suture without protection don't carry the complications to the anastomosis. Didn't occour complications, in the fact the replaced lobes occupated only half pleural cavity. The most important complication was pulmonary infarct and total dehiscence of the chest wall. The bronchography was efficient to study bronchial anastomosis. Scintigraphy was useful to quantify the relative pulmonary mass functioning in vivo.
PURPOSE: To study the bronchial and vascular anastomosis in the autologus lobar lung implant and show if exist complications in transplants occuping only half of pleural cavity. METHODS: We studied 15 male from 8 to 14kg. After pneumonectomy in the left chest wall we replaced the caudal lobe. In the late post operative we made bronchography and perfusion's scintigraphy and analysed the lungs after sacrified the animal. RESULTS: Four dogs died, one by early dehiscence of bronchial anastomosis, one by infection, and two by lung infarct after occlusion of lung vein in place of anastomosis. The relative perfusion of right and left lung were 72,7% and 27,3% respectively. The bronchography didn't show stenosis nor other alterations in bronchial anastomosis. After opened the thorax we saw that caudal lobe there was filled all pleural cavity without shift of the mediastinum. CONCLUSIONS: The study showed that the end to end suture without protection don't carry the complications to the anastomosis. Didn't occour complications, in the fact the replaced lobes occupated only half pleural cavity. The most important complication was pulmonary infarct and total dehiscence of the chest wall. The bronchography was efficient to study bronchial anastomosis. Scintigraphy was useful to quantify the relative pulmonary mass functioning in vivo.
Descrição
Palavras-chave
Pneumonectomia, Transplante autólogo, Transplante de pulmão, Cães, Pneumonectomy, Autologus transplantation, Lung, transplantation, Dogs
Como citar
Acta Cirúrgica Brasileira. Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, v. 20, n. 4, p. 311-316, 2005.