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Transcription

1 6D OÕNOÕ$QQH. SHNWHQ<DYUXVXQD$NFL HU/RE7UDQVSODQWDV\RQX Dr. Ömer Soysal 1, 'U $EGXOODK $\GÕQ 2, 'U 6DPL hqvdogõ 3, Dr. Erdal Ege 1, Dr. Metin Gülcüler 1, Dr. Hasan Özdemir 1, Dr. Öner Gülcan 1, 'U +DUXQ dõudoõn 2, Dr. Mustafa Paç 1 $NFL HU WUDQVSODQWDV\RQXQGD GRQ U D]OÕ Õ YH UHMHNVL\RQ orn QHPOL VRUXQODUGÕU (EHYH\QGHQ ORE WUDQVSODQWDV\RQX EX VRUXQODUD o ] P RODELOLU 0HUNH]LPL] KD\YDQ ODERUDWXDUÕQGD ELU DQQHGHQ LNL \DYUX\D ELUHU DNFL HU OREX YH ELU DQQHGHQ ELU \DYUX\D ELU DNFL HU OREX WUDQVSODQWDV\RQX JHUoHNOHúWLULOPLúWLU $PHOL\DWODU NDUGL\RSXOPRQHU E\SDV NXOODQÕOPDGDQ VDQWUDO YHQ ] EDVÕQo LQYD]LY DUWHUL\HO EDVÕQo YH RNVLMHQDV\RQ WDNLEL LOH JHUoHNOHúWLULOPLúWLU 6DGHFH SUHRSHUDWLI WHN GR] VWHURLG GÕúÕQGD LPP QVXSUHVLI PHGLNDV\RQ \DSÕOPDPÕúWÕU $QQH\H VRO SQ PRQHNWRPL \DSÕOÕS LNL ORE D\UÕODUDN DQQHQLQ LNL \DYUXVXQD VRO SQ PRQHNWRPL\L WDNLEHQ ELUHU ORE VRO DNFL HU \HULQH WUDQVSODQWH HGLOPLúWLU %LU GL HU DQQH\H LVH VRO DOW OREHNWRPL YH \DYUXVXQD VRO SQ PRQHNWRPL \DSÕOPÕú YH DQQHGHQ oõnduwõodq ORE SQ PRQHNWRPL]H \DYUX\D VRO DNFL HU RODUDN WUDQSODQWH HGLOPLúWLU 3Q PRQHNWRPL \DSÕODQ DQQH SRVWRSHUDWLI DQHVWH]L NRPSOLNDV\RQX QHGHQL\OH HNVLWXV ROPXú ELUHU ORE WUDQVIHUL \DSÕODQ \DYUX N SHNOHU SRVWRSHUDWLI YH VDDW \DúDPÕú YH VROXQXP \HWPH]OL L QHGHQL\OH ND\EHGLOPLúWLU /REHNWRPL \DSÕODQ LNLQFL DQQHGH LVH SRVWRSHUDWLI VRUXQ ROPDPÕú IDNDW ORE DOÕFÕVÕ \DYUX WUDVSODQWDV\RQXQ DOWÕQFÕ J Q DNXW DOYHROHU KDVDU QHGHQL\OH ND\EHGLOPLúWLU. SHNOHUGH DNFL HU ORE WUDQVSODQWDV\RQX WHNQLN RODUDN P PN QG U &DQOÕGDQ ORE WUDQVSODQWDV\RQX ]HOOLNOH SHGLDWULN \Dú JUXEXQGDNL DNFL HU GRQ U D]OÕ Õ VRUXQXQD ELU o ] P RODELOLU >7XUJXW g]do 7ÕS 0HUNH]L Dergisi 1996;3(4): ] Anahtar Kelimeler $NFL HU ORE WUDQVSODQWDV\RQ Donor shortage and rejection are very important problems in lung transplantation. Lobar transplantation from parents may be a solution for these problems. Two lobar transplantations from a mother dog to two puppies and one lobar transplantation from annother mother to one puppy were performed in our animal laboratory. Operations were performed without cardiopulmonary bypass, and central venous pressure, invasive arterial pressure and oxygenation were monitorized. Any immune suppresive medication was not used except one dose of preoperative corticosteroid. The mother underwent left pneumonectomy, then two lobes were prepared and transplanted to the left hemithoraces of two pneumonectomized puppies as left lungs. Left lower lobectomy was performed in the other mother dog and that lobe was transplanted to her pneumonectomized puppy as left lung. The mother underwent pneumonectomy died postoperatively because of anesthetic complications and each of two puppies received pulmonary lobes lived for 9 and 17 hours postoperatively and died because of respiratory insufficiency. The second mother underwent lobectomy survived without any complication but her puppy received left lower lobe died on postoperative day six from acute alveolar damage. Pulmonary lobar transplantation is technically feasible in dogs. Living-related lobar transplantation may be a solution for donor shortage problem in pediatric age group. [Journal of Turgut Özal Medical Center 1996;3(4): ] Key Words: Pulmonary, lobe, transplantation øq Q hqlyhuvlwhvl 7ÕS )DN OWHVL * V.DOS 'DPDU &HUUDKLVL $QDELOLP 'DOÕ 0DODW\D øq Q hqlyhuvlwhvl 7ÕS )DN OWHVL 3DWRORML $QDELOLP 'DOÕ 0DODW\D )ÕUDW hqlyhuvlwhvl 9HWHULQHUOLN )DN OWHVL &HUUDKL $QDELOLP 'DOÕ $QHVWH]L %LOLP 'DOÕ (OD]Õ 284

2 Soysal Ö, et al. $NFL HU WUDQVSODQWDV\RQX J Q P ]GH ]HOOLNOH ED]Õ PHUNH]OHUGH VRQ G QHP DNFL HU KDVWDOÕ Õ LoLQ UXWLQ ELU LúOHP ROPXú YH HULúNLQOHUGH EDúDUÕOÕ VHULOHU \D\ÕQODQPÕúWÕU $NFL HU WUDQVSODQWDV\RQXQGD GRQ U D]OÕ Õ RUJDQ E \ NO N X\XPVX]OX X YH UHMHNVL\RQ GL HU RUJDQ WUDQVSODQWDV\RQODUÕQGDQ GDKD ID]OD RODUDN VRUXQ ROPDNWDGÕU øon EDúDUÕOÕ FDQOÕGDQ solid organ nakli böbrek transplantasyonunda JHUoHNOHúWLULOPLúWLU 3HGLDWULN \Dú JUXEXQGD FDQOÕGDQ ]HOOLNOH GH HEHYH\Q YH\D ELULQFL GHUHFH DNUDEDGDQ DNFL HU ORE WUDQVSODQWDV\RQX LOH \XNDUÕGD VD\ÕODQ FLGGL VRUXQODUD o ] P JHWLULOHELOLU Teknik olarak lob transplantasyonunun durumunu, LPP QV SUHV\RQXQ JHUHNOL ROXS ROPDGÕ ÕQÕ YH OREDU JUHIWLQ \DYUX\D \HWHUOL ROXS ROPD\DFD ÕQÕ VDSWDPDN LoLQ DQQHGHQ \DYUX N SH H DNFL HU ORE WUDQVSODQWDV\RQX \DSÕOPÕú YH LON VRQXoODUÕPÕ] VXQXOPXúWXU MATERYAL VE METOD 7XUJXW g]do 7ÕS 0HUNH]L KD\YDQ ODERUDWXDUÕQGD LNL DQQHGHQ o \DYUX\D DNFL HU ORE WUDQVSODQWDV\RQX \DSÕOPÕúWÕU.DQJDONXUW NÕUPDVÕ RODQ LNL DQQHGHQ ELUL NJ YH \DYUXODUÕ YH NJ LGLOHU 'L HU DQQH 35 kg ve yavrusu 7 kg idi. Köpekler 10 gün süre ile J ]OHP DOWÕQGD WXWXOGX YH GHULGHNL SLUH YH EHQ]HUL parazitler ve intestinal parazitoz için medikasyon \DSÕOGÕ 3UHPHGLNDV\RQ QFH PJNJ DWURSLQ VF YH GDKD VRQUD PONJ 5RPSXQ LP LOH VD ODQGÕ 6RO SRVWHURODWHUDO WRUDNRWRPL LQVL]\RQ KDWWÕ KHU LNL IHPRUDO DUWHU ORMODUÕ NRWHU SOD ÕQÕQ \HUOHúWLULOHFH L VD DUND EDFDN DOW E OJHVL (.* HOHNWURW ORMODUÕ YH SXOVH RNVLPHWUHQLQ \HUOHúWLULOHFH L NX\UXN XFXQGDQ FPOLN E OJH WUDú HGLOGL Anestezi ve intraoperatif monitörizasyon: øqg NVL\RQ DQHVWH]LVL SHQWRWDO LOH VHIDOLN YHQGHQ GLUHNW HQMHNVL\RQ LOH VD ODQÕS SDOSHEUDO UHIOHNV LOH NRQWURO HGLOGL (QW EDV\RQGD EDúDUÕOÕ ROXQDPDPD HQGLúHVL\OH HQW EDV\RQ QFHVL NDV JHYúHWLFL NXOODQÕOPDGÕ 2Q QXPDUD ODULQJRVNRS EODGH L NXOODQÕODUDN QXPDUD SODVWLN HQW EDV\RQ W S LOH HQW EDV\RQ VD ODQGÕNWDQ VRQUD DQHVWH]L PJNJ 1RUNXURQ LY YH ø]riorudq D]RW SURWRNVLW YH RNVLMHQ inhalasyonu ile devam etti. 6DQWUDO YHQ ] EDVÕQo WDNLEL YH LY VÕYÕ UHSODVPDQÕ MXJXOHU YHQH DoÕN FHUUDKL WHNQLN LOH \HUOHúWLULOHQ NDWHWHU LOH DUWHUL\HO EDVÕQo WDNLEL IHPRUDO DUWHUH \HUOHúWLOHQ NDWHWHU LOH YH RNVLMHQDV\RQ WDNLEL LVH WUDú HGLOPLú NX\UX D WDNÕODQ SXOVH RNVLPHWUH LOH VD ODQGÕ $PHOL\DW V UHVLQFH LGUDU oõnõúõ LGUDU VRQGDVÕ LOH takip edildi. Verici operasyonu $OWÕQFÕ LQWHUNRVWDO DUDOÕNWDQ WRUDNRWRPL \DSÕOGÕ.RPSOHW ILVV U RODQ LNL ORE YDUGÕ 6RO DQD SXOPRQHU DUWHU YH VRO DQD EURQú P PN Q ROGX X NDGDU SURNVLPDOGHQ YH NDXGDO ORED DLW o NUDQL\HO ORED DLW LNL SXOPRQHU YHQ D\UÕ D\UÕ P PN Q ROGX X NDGDU NDOEH \DNÕQ NHVLOGL YH SQ PRQHNWRPL WDPDPODQPÕú ROGX 5H]HNVL\RQ VÕUDVÕ DUWHUYHQEURQú úhnolqgh JHUoHNOHúWLULOGL YH DUWHULQ NHVLOPHVLQGHQ EHú GDNLND QFH QLWHNJ KHSDULQ LY \DSÕOGÕ ønlqfl DQQHGH LVH VRO DOW OREHNWRPL \DSÕOGÕ $NFL HULQ VDNODQPDVÕ: Pulmoner arterden; buzlu, ringer laktat kullanilarak 60 cclik enjektör ile VÕYÕ EHUUDN JHOHQH YH DNFL HU EH\D]ODúDQD NDGDU \ÕNDPD \DSÕOGÕ +HU LNL OREXQ GDPDUODUÕ YH EURQúODUÕ GLNNDWOH D\UÕOGÕ /REODU EURQúGDQ G UW QXPDUD HQGRWUDNHDO W S DUDFÕOÕ Õ\OD úlúlulogl YH úlú WXWXOGX 'DKD VRQUD VWHULO úduwodugd EX]OX ULQJHU ODNWDW LoLQGHNL DNFL HU VDQWLJUDW GHUHFHGH VDNODQGÕ $OÕFÕ RSHUDV\RQX <DYUX N SH H VRO SQ PRQHNWRPL \DSÕOGÕ 3XOPRQHU DUWHU NHVLOPHGHQ EHú GDNLND QFH QLWHNJ KHSDULQ YHULOGL 3Q PRQHNWRPL VÕUDVÕQGD \DYUX N SHNWH NDODQ GDPDU YH EURQú J G NOHUL X]XQ WXWXOGX %URQú LoLQH DPHOL\DW VDKDVÕQGDQ IROH\ VRQGD \HUOHúWLULOLS úlúlulogl YH E \OHFH EURQúD NOHPS NRQXOPDGÕ øpsodqwdv\rqd EURQú LOH EDúODQGÕ YH WHN WHN YLNULO LOH EURQú DQDVWRPR]X JHUoHNOHúWLULOGL %LULQFL \DYUX N SH LQ ELU SXOPRQHU YHQL DQQHGHQ DOÕQDQ OREXQ ELU pulmoner veni ile ucuca 50 prolen ile anastomoz HGLOGL YH WUDQVSODQWH HGLOHQ OREXQ GL HU LNL SXOPRQHU YHQL LVH GLUHNW \DYUXQXQ VRO DWULDO DXULNXODVÕQD Xo yan anastomoz edildi. Takiben pulmoner arter 50 SUROHQ LOH XFXFD DQDVWRPR] HGLOGL ønlqfl \DYUX köpekte ise transplante edilen lobun iki pulmoner veni de direkt sol atrial appendikse sütüre edildi. <DYUXQXQ ERúWD NDODQ SXOPRQHU YHQOHUL ED ODQGÕ Pulmoner arter sütürü bittikten sonra arterdeki NOHPS DoÕOGÕ YH EURQú LoLQGHNL IROH\ VRQGD oõnduõodudn EURQú GLNLúL WDPDPODQGÕ $NFL HULQ YHQWLOH ROGX X YH NDQODQGÕ Õ YH SDOSDV\RQ LOH DUWHUGH YH YHQOHUGH DNÕPÕQ ROGX X VDSWDQGÕ 5HVLP +HPRVWD]Õ WDNLEHQ SOHYUDO ERúOX D ELU DGHW QXPDUD FKHVW W S \HUOHúWLULOGL YH WRUDNRWRPL VWDQGDUW \ QWHPOH NDSDWÕOGÕ (NVW EDV\RQGDQ QFH GLNNDWOL ELU úhnlogh WUDNHDO DVSLUDV\RQ \DSÕOGÕ. SHNOHU WDP RODUDN X\DQGÕNWDQ VRQUD E W Q GDPDU \ROODUÕ (.* Journal of Turgut Özal Medical Center 3(4):

3 6D OÕNOÕ DQQH N SHNWHQ \DYUXVXQD DNFL HU ORE WUDQVSODQWDV\RQX Ö. Soysal ve ark. ZHGJH UH]HNVL\RQ LOH ORE N o OW OG YH VÕ PDVÕ VD ODQGÕ 5HVLP %X \DYUX LVH SRVWRSHUDWLI DOWÕQFÕ gün kardiyak ve respiratuar arrest ile kaybedildi. SONUÇLAR Resim 1. /RE LPSODQWDV\RQX VRQXQGD VROGDQ VD D GR UX EURQú DUWHU YH YHQ DQDVWRPR]ODUÕ L]OHQL\RU Resim 2. /RE LPSODQWDV\RQX VRQUDVÕ YHQWLODV\RQOD OREXQ WRUDNV ERúOX XQGDQ WDúPDVÕ L]OHQL\RU %LULQFL DQQHGHQ \DSÕODQ LNL DGHW OREDU transplantasyonda birinci yavru için iskemi süresi üç VDDW LNLQFL \DYUX N SHN LoLQ EHú VDDW ROPXúWXU +HU LNL \DYUX GD HNVW EH HGLOPLú YH SRVWRSHUDWLI ELUL YH GL HUL VDDW \DúDPÕúODUGÕU go P QHGHQOHUL QHW RODUDN DQODúÕODPDPÕú FHUUDKL WHNQLN DoÕVÕQGDQ ELU VRUXQ ROPDPÕú IDNDW \DYUX N SHNOHU \ ]H\HO YH KÕ]OÕ VROXQXP WDúLNDUGL VRQXFX JHOLúHQ VROXQXP \HWPH]OL L QHGHQL\OH ND\EHGLOPLúOHUGLU 3RVWPRUWHP LQFHOHPHGH GDPDU YH EURQú DQDVWRPR]ODUÕQÕQ DoÕN ROGX X YH DNFL HULQ NDQODQGÕ Õ WHVELW HGLOGL )DNDW WUDQVSODQWH DNFL HU OREXQXQ EURQúODUÕQÕQ QHPOL ELU E O P Q Q VHNUHV\RQOD WDP WÕNDOÕ ROGX X J ]OHQGL $NFL HULQ KLVWRSDWRORMLN LQFHOHPHVLQGH SROLPRUI Q YHOL O NRVLWOHUGHQ ROXúDQ LQIODPDV\RQ YH DOYHRO GXYDUÕQGD K\DOHQ PHPEUDQ ROXúXPX WHVELW HGLOGL (Resim 3). ønlqfl DQQH \DSÕODQ ELU DGHW ORE WUDQVIHULQL WDNLEHQ HNVW EH HGLOPLú YH SRVWRSHUDWLI VRUXQX ROPDGDQ QRUPDO J QO N DNWLYLWHVLQH G QP úw U (Resim 4). Bu tranplantasyonda iskemi süresi iki VDDW ROPXú YH \DYUX SRVWRSHUDWLI G QHPGH LON J Q QRUPDO JÕGD YH VÕYÕ DOÕPÕQD EDúODPÕú IDNDW WDNLEHGHQ J QOHUGH RUDO DOÕPÕ JLGHUHN D]DOPÕú DNFL HU HQIHNVL\RQX QHGHQL\OH ND\EHGLOPLúWLU 3RVWPRUWHP SDWRORMLN LQFHOHPHVL ELULQFL odoõúpdgdnl LNL \DYUX LOH EHQ]HU EXOJXODU J VWHUPLúWLU Resim 3. 3ROLPRUI Q YHOL O NRVLWOHUGHQ ROXúDQ LQIODPDV\RQ YH GHP 2UWDGD DOYHRO GXYDUÕQGD K\DOHQ PHPEUDQ ROXúXPX GLNNDWL ohnphnwhglu HOHNWURWODUÕ YH J V W S ohnlogl 3RVWRSHUDWLI analjezi metamizol ile ve antibiyotik profilaksisi 30 PJNJ VHIWULDNVRQ LOH VD ODQGÕ %LULQFL \DYUX postoperatif 9., ikinci yavru ise postoperatif VDDWWH VROXQXP \HWPH]OL L YH DUUHVWL LOH kaybedildi. Üçüncü transplantasyonda anneye sol alt OREHNWRPL \DSÕOGÕ YH D\QÕ SURVHG U L]OHQHUHN \DYUX\D WUDQVSODQWDV\RQ JHUoHNOHúWLULOGL /REXQ \DYUXQXQ WRUDNV ERúOX XQD VÕ PDPDVÕ ]HULQH Resim 4. 3RVWRSHUDWLI WDNLSGH VÕN DNFL HU GD NXOODQÕOPÕúWÕU RVN OWDV\RQX 7$57,ù0$ $NFL HU ORE transplantasyonu özellikle çocuklarda organ E \ NO YH YHULFL D]OÕ Õ VRUXQODUÕQD o ] P RODELOLU $NFL HU nakli için bekleyen KDVWD VD\ÕVÕ DUWPDVÕQD YHULFL VD\ÕVÕQGDNL DUWPD HúOLN HGHPHPHNWH YH DNFL HU WUDQVSODQWDV\R nu için bekleyenlerin \DNODúÕN VL 286

4 Soysal Ö, et al. EHNOHPH SHUL\RGXQGD GRQ U EXOXQDPDGÕ Õ LoLQ OPHNWHGLU drfxnodugd DNFL HU WUDQVSODQWDV\RQXQGD o VHoHQHN YDUGÕU E \ NO X\JXQ orfxn YHULFL orfxn WRUDNVÕQD X\DELOPHVL LoLQ N o OW OHQ HULúNLQ DNFL HUL YH VRQ RODUDN GD FDQOÕGDQ lob veya segment transplantasyonu. Pediatrik DNFL HU WUDQVSODQW KDVWDODUÕ EX o PHWRWWDQ KDQJLVLQLQ HQ X\JXQX ROGX XQD NDUDU YHUHELOHFHN NDGDU V UYLYH \H KHQ ] VDKLS GH LOOHUGLU /RE transplantasyonu ile bir vericiden (tercihen kadavra YHULFLVL ELUGHQ ID]OD DOÕFÕ\D QDNLO P PN QG U ddoõúpdpõ]gd ELU DQQHGHQ LNL D\UÕ \DYUX\D ORE WUDQVIHUL JHUoHNOHúWLULPLúWLU %LULQFL GHUHFHGHQ akraba, tercihen ebeveynden, lob naklinin DYDQWDMODUÕ DUWPÕú YHULFL VD\ÕVÕ HOHNWLI DPHOL\DW úduwoduõ NÕVD LVNHPL ]DPDQÕ KHU ]DPDQ bulunabilmesi, gündüz ameliyat, normal bir DNFL HULQ QDNOL YH GDKD L\L GRNX X\XPX úhnolqgh özetlenebilir. %X SLORW odoõúpdpõ]gd HULúNLQ DQQH N SHNWHQ yavruya pulmoner lob naklinin teknik olarak P PN Q ROGX XQX J VWHUPLú ROGXN 9HULFL SQ PRQHNWRPL YH\D OREHNWRPLVL HVQDVÕQGD GDPDU J G NOHULQLQ X]XQ WXWXOPDVÕ DUWHUGH YH YHQGH REOLN XFXFD DQDVWRPX]XQX P PN Q NÕODELOLU %L] DUWHUGH XFXFD QRUPDO DQDVWRPR] X\JXODGÕN YH SRVWPRUWHP odoõúpdgd DUWHU DQDVWRPR] KDWWÕQÕQ DoÕN ROGX XQX IDNDW GDUDOPDQÕQ EXOXQGX XQX WHVELW HWWLN 9HQ anastomuzunda ise venlerin direkt anastomuzu \HULQH GLUHNW DOÕFÕQÕQ VRO DWUL\DO DSSHQGLNVLQH anastomuzun teknik olarak daha rahat ve uygun ROGX XQX J UG N 9HULFL SQ PRQHNWRPLVLQGH YHQOHUL DOÕFÕQÕQ DWUL\DO FXII Õ LOH ELUOLNWH oõnduwõopdvõ WDYVL\H HGLOPHNWH\VH GH FDQOÕGDQ QDNLOGH YHULFLQLQ DWUL\XPXQD UH]HNVL\RQ \DSÕOPDVÕQÕQ X\JXQ ROPDGÕ ÕQÕ EL]LP X\JXODGÕ ÕPÕ] JLEL SXOPRQHU YHQLQ GLUHNW DOÕFÕ DWUL\XPD V W UH HGLOHELOHFH LQL J UG N %URQúXQ NOHPSOHQPHVLQLQ EURQú L\LOHúPHVLQH ]DUDUOÕ HWNLVLQLQ ID]OD ROPDGÕ Õ YH E \OHFH L\L ELU DPHOL\HW VDKDVÕ NRQWURO Q Q \DSÕODELOGL L ELOGLULOPHVLQH UD PHQ EL] EURQúX kestikten sonra steril sahadan foley sonda kullanarak EURQú J G Q NRQWURO HWWLN YH EURQú L\LOHúPHVLQH N W HWNLVL RODELOHFH LQL G ú QHUHN DOÕFÕ EURQúXQX NOHPSOHPHPLú ROGXN /REDU WUDQVSODQWWD ELU GL HU VRUX KDQJL OREXQ WUDQVSODQWDV\RQD X\JXQ ROGX XGXU 7UDQVIHU HGLOHQ ORE R KHPLWRUDNVD VÕ PDOÕGÕU DUWHUL P PN QVH ELU WDQH HQ ID]OD LNL WDQH ROPDOÕGÕU YHQ ] G Q ú DQDVWRPR]D X\JXQ NDOÕQOÕN YH X]XQOXNWD ROPDOÕGÕU YH EURQúX DQDVWRPR]D X\JXQ ROPDOÕGÕU %X NRQXGD HQ VÕNÕQWÕOÕ DQDVWRPR] YHQ ] DQDVWRPR]GXU o QN YHQOHULQ XFXFD DQDVWRPR]X orn ]RU ROXS VD\ÕODUÕ GD birbirleriyle uyumlu olmayabilir. Bu durumda transfer edilen lobun venleri uç yan teknik ile DOÕFÕQÕQ VRO DWULDO DSSHQGLNVLQH V W UH HGLOHELOLU $WULDO DQDVWRPR] YH GL HU DQDVWRPR]ODUGD WURPE V profilaksisi için postoperatif heparinizasyona devam HGLOPHVL X\JXQ ROPDNWDGÕU %DúND odoõúpdodugd \HQLGR DQGD RUWD ORE YH\D RUWD OREXQ DQWHULRU VHJPHQWLQLQ orfxnodugd DOW OREODUÕQ X\JXQ ROGX X ELOGLULOPLúWLU %L] EX X\XPX D ÕUOÕN X\XPX LOH VD ODGÕN IDNDW ELU \DYUXGD VÕ PD\DQ OREX ZHGJH UH]HNVL\RQ LOH N o OWPHN ]RU ROPDGÕ %X N o OWPHQLQ GLNNDWOH \DSÕOPDVÕ YH E \ NoH ELU OREXQ \HUOHúWLULOPHVL LOH PHGLDVWLQDO úliwh \RO DoÕOPDPDVÕ JHUHNOLGLU 8\JXQ OREXQ VHoLPLQLQ preoperatif kompüterize tomografideki ölçümlerle GH \DSÕOPDVÕ P PN QG U $QQHGHQ orfx D QDNLO V ]NRQXVX ROGX X LoLQ LPP QV SUHV\RQ G ú QPHPLú YH JHUHNOL ROXS ROPDGÕ ÕQÕ WHVW HWPHN LVWHPLúWLN IDNDW EX VRUXQXQ FHYDEÕQÕ EXODELOHFHN V UH \DYUXODUÕ \DúDWDPDGÕN Tahmin ediyoruz böyle bir nakilde de LPP QVXSUHV\RQXQ \DSÕOPDVÕ JHUHNHFHN IDNDW E \ N LKWLPDOOH LPP QV SUHVLI LODoODUÕQ VD\ÕVÕ YH GR]ODUÕ GDKD G ú N RODELOHFHNWLU Lobar transplantasyonda transfer edilen lobun, DOÕFÕQÕQ VROXQXP IRQNVL\RQODUÕ LoLQ \HWHUOL ROXS RODPD\DFD ÕQD GD EX N o N odoõúpdpõ]gd FHYDS EXODPDGÕN o QN SODQODGÕ ÕPÕ] JLEL ELU D\ VRQUD NDUúÕ DQD SXOPRQHU DUWHULQ RNO ]\RQX LOH \DSDFD ÕPÕ] odoõúpdodu LoLQ \HWHUOL V UH \DúDPDGÕODU <DYUXODUÕQ O P QHGHQOHUL KLVWRSDWRORMLN WDQÕ LOH GH GHVWHNOHQGL L JLEL DNXW DOYHROHU KDVDU GL\H WDQÕPODQDQ YH VROXQXP \HWPH]OL LQH \RO DoDQ LQIODPDWXDU GXUXPGXU $\UÕFD ELU \DYUXGD SRVWRSHUDWLI LNLQFL J Q ohnlohq DNFL HU grafisi ile tesbit edilen orta derecede mediastinal úliwlq GH ROXPVX] HWNLOHUL ROPXú RODELOLU Köpeklerde anneden yavruya lobar transplantasyon teknik olarak mümkündür. Peroperatif anestezik manipülasyon ve vital ve hemodinamik parametrelerin takibi önemlidir. 3RVWRSHUDWLI G QHP HQ VÕNÕQWÕOÕ G QHPGLU SRVWRSHUDWLI DQDOMH]L PXWODND VD ODQPDOÕ VÕFDN YH UDKDW ELU RUWDPGD EDUÕQGÕUÕOPDOÕ EHVOHQPH LKWL\DoODUÕ orn L\L VD ODQPDOÕGÕU /REXQ WUDQVIHULQGHQ QFH EURQúLDO \DSÕ orn L\L DVSLUH edilmeli ve ekstübasyondan hemen önce de mutlaka Journal of Turgut Özal Medical Center 3(4):

5 6D OÕNOÕ DQQH N SHNWHQ \DYUXVXQD DNFL HU ORE WUDQVSODQWDV\RQX Ö. Soysal ve ark. dikkatli bir trakeal aspirasyon ile sekresyon ve VDNODPD HVQDVÕQGD EURQú LoLQH GRODQ VÕYÕODU WHPL]OHQPHOLGLU %X LúOHPLQ SRVWRSHUDWLI JHOLúHELOHFHN DWHOHNWD]L YH HQIHNVL\RQXQ NRQWURO DoÕVÕQGDQ QHPL E \ NW U &DQOÕGDQ DNFL HU ORE WUDQVSODQWDV\RQXQXQ DNFL HU QDNOLQGHNL GRQ U D]OÕ Õ VRUXQXQD o ] P RODELOHFH LQL G ú QPHNWH\L] KAYNAKLAR 1. Cooper JD, Pearson FG, Patterson GA. Technique of successful lung transpantation in humans. J Thorac Cardiovasc Surg 1987;93: Murray JE, Merril JP, Harrison JH. Kidney transplantation between seven pairs of identical twins. Ann Surg 1958;148: Veith FJ. Lung transplantation in perspective (editorial). N Engl J Med 1987;314: Soysal Ö. Lobar pulmonary transplantation. Journal of Turgut Özal Medical Center 1996;3(2): Craig WL, Everts E, Shamberger RC. Reduced-size lung transplantation from adult to neonatal sheep. J Pediatr Surg 1992;27(8): Jennings RW, Lorenz HP, Duncan BW, Bradley SM. Adultto-neonate lung transplantation: anatomic considerations. J Pediatr Surg 1992;27: Bisson A, Bonnette P, Kadi NBE, Leroy M, Colchen A. Bilateral pulmonary lobe transplantation: left lower and right middle and lower lobes. Ann Thorac Surg 1994;57: Starns VA, Lewiston NJ, Likart H, et al. Current trends in lung transplantation: lobar transplantation and expanded use of single lungs. J Thorac Cardiovasc Surg 1992;104: <D]ÕúPD DGUHVL: Yrd.Doç.Dr. Ömer SOYSAL øq Q hqlyhuvlwhvl 7ÕS )DN OWHVL * V.DOS 'DPDU &HUUDKLVL $%' MALATYA Tel: Fax: