【摘要】 目的 为提高供者器官的利用率，探讨将同一供者的心、肺同期移植给不同受者的可行性及手术方法。方法 采用原位灌洗、整块切取的方法获得3例供者的心脏和双肺，分别同期移植给3例终末期心脏疾病患者和3例终末期肺脏疾病患者。供者先行机械通气，然后开胸，主动脉及肺动脉分别插入灌注管，经主动脉插管灌注HTK液，经肺动脉插管灌注改良棉子糖低钾右旋糖酐液，对心、肺进行灌洗，然后整块切取心、肺。受者手术前在进行心、肺的分离，然后再次进行心、肺的逆行灌洗（通过上、下肺静脉插管和主动脉根部或者经腔静脉冠状窦逆行插管）。施行单侧肺移植者，再将左、右供肺分离。3例肺移植受者中，1例行左单肺移植，其他2例为非体外循环下序贯式双肺移植；3例心脏移植者均采用双腔静脉吻合法施行原位心脏移植。结果 1例左单肺移植受者术后恢复良好；1例双肺移植受者术后出现右肺上叶静脉栓塞，于术后第9天再次手术，切除右肺上叶，后痊愈出院；另1例双肺移植受者，术后出现气管吻合口狭窄，并发肺部感染，经对症治疗后好转出院，术后7个月死于重症感染。1例心脏移植受者术后早期出现肾功能衰竭，经血液透析治疗后痊愈出院，3例心脏移植受者术后生活质量良好，心功能恢复到0~Ⅰ级。结论 将同一供者的心、肺分别移植给不同受者，能充分利用供者器官，方法可行，效果良好。
【关键词】 组织供者；心脏移植；肺移植
Transplantation from same donor to different recipients with end -stage heart or lung disease Xu Ning Chen Jing-Yu Xie Qiang，el al. Department of Thracic Surgery, Affiliated Hospital, Dalian University, Dalian 116021, China
【Abstract】 Objective To study the possibility of heart and lung transplantation to different recipients with same donor’s heart and lung in our country. Method Three groups patients were carefully selected in our hospital from 1 January to 1 July 2005. Each group patients included one lung recipient with end-stage lung disease and one heart recipient with end-stage heart disease. Both patients had same blood type. Heart and lung transplantation performed separately in the meantime in our center. Lung and heart were donated by the same donor. Result In 2 double-lungs transplantation patients, one had developed venous embolism and conduct right pulmonary upper lobectomy on the 9th day, the other got infection and cured after antibiotics used. One heart transplant patient occured renal dysfunction and then was treated with consecutive renal replacement therapy (CRRT). The remainings patients had not postoperative complications. All these recipients got through the postoperative period and have good life quality. Conclusion Heart and lung transplantation to different recipients from same donor’s heart and lung can maximise the use of available donor and save more patient’s lives．It should be popular in our country．
【Key words】 Tissue donors；Heart transplantation；Lung transplantation
