BACKGROUND

Phrenic nerve injury (PNI) is a complication of lung transplantation related to the surgical procedure and associated with increased morbidity. However, the incidence and risk factors, specifically regarding surgical techniques, have not been adequately studied.

METHODS

We conducted a prospective single-center study over 4-years, in recipients of lung transplantation with a normal pretransplant phrenic nerve conduction study (PNCS). Diaphragm ultrasound and PNCS were performed in the first 21 postoperative days and PNI was defined when both tests were abnormal. Patients were followed up until hospital discharge. The association between transplant characteristics and PNI was analyzed by using logistic regression models.

RESULTS

Two hundred eleven lung grafts implanted in 127 patients were included in the study. After lung transplantation, PNI was diagnosed in 43.3% of the subjects and 29% of the operated hemithorax. Regression logistic model showed that the variables related to PNI were female gender (p = 0.02), bilateral lung transplantation (BLT) (p = 0.001), right lung graft (p = 0.003), clamshell incision (p = 0.01), mediastinal adhesions (p = 0.002), longer operative time (p = 0.003), intraoperative extracorporeal support (p = 0.02), and blood transfusion (p = 0.003). Conversely, age >61 years (p = 0.008) and higher thoracic diameter (p = 0.04) were protective factors. The use of electrocautery, cardiac mechanical retractors, and diaphragmatic traction was not associated with PNI. Morbidity was increased without any difference in mortality.

CONCLUSIONS

PNI is a frequent complication after lung transplantation, associated with higher morbidity. Mainly risk factors were age, BLT, female gender, and variables related to surgical difficulties. Lung graft in the right hemithorax and mediastinal adhesiolysis were the most relevant technical variables.

中文翻译：

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肺移植术后膈神经损伤的前瞻性评估：发病率、危险因素及手术过程分析

背景

膈神经损伤 (PNI) 是与外科手术相关的肺移植并发症，并与发病率增加有关。然而，发病率和风险因素，特别是关于手术技术的，尚未得到充分研究。

方法

我们对接受正常移植前膈神经传导研究 (PNCS) 的肺移植受者进行了一项为期 4 年的前瞻性单中心研究。在术后前 21 天进行膈肌超声和 PNCS，当两项检查均异常时定义为 PNI。随访患者直至出院。使用逻辑回归模型分析移植特征与 PNI 之间的关联。

结果

该研究包括在 127 名患者中植入的 211 颗肺移植物。肺移植后，43.3% 的受试者和 29% 的手术侧胸患者被诊断为 PNI。回归logistic模型显示，与PNI相关的变量为女性（p  =0.02）、双侧肺移植（BLT）（p  =0.001）、右肺移植（p  =0.003）、翻盖切口（p  =0.01）、纵隔粘连( p  = 0.002)、更长的手术时间 ( p  = 0.003)、术中体外支持 ( p  = 0.02) 和输血 ( p  = 0.003)。相反，年龄 > 61 岁 ( p = 0.008）和更大的胸径（p  = 0.04）是保护因素。电灼、心脏机械牵开器和膈肌牵引的使用与 PNI 无关。发病率增加，死亡率没有任何差异。

结论

PNI 是肺移植后常见的并发症，与较高的发病率相关。主要危险因素是年龄、BLT、女性以及与手术困难相关的变量。右半胸肺移植和纵隔粘连是最相关的技术变量。