四例慢性阻塞性肺病行单肺移植的体会

目的 总结同种异体肺移植治疗慢性阻塞性肺病的体会。方法 4例慢性阻塞性肺病患者，1例为双肺弥漫性肺气肿，另3例为双肺重度弥漫性肺气肿并部分相互融合成肺大疱，但肺大疱占据胸腔不足1／3。4例均接受尸体供肺移植，为双肺弥漫性肺气肿的1例接受右肺移植，弥漫性肺气肿并部分相互融合成肺大疱的3例接受左肺移植，此3例分别于术中（1例）和术后（2例）接受右肺减容术。术后采用他克莫司、霉酚酸酯及泼尼松预防排斥反应，同时给予达利珠单抗或抗胸腺细胞球蛋白进行诱导治疗。结果4例手术经过顺利，1例术后第5d发生急性排斥反应，经甲泼尼龙冲击治疗逆转。2例受者顺利出院，并存活至今，最长1例存活已超过2年。2例分别于肺移植术后第74d、77d死亡。结论 终末期双肺弥漫性肺气肿可行单侧肺移植治疗，如果对侧肺有重度弥漫性肺气肿，特别是部分融合成大疱易破裂者，可同期期行对侧肺减容。

Single allograft lung transplantation in 4 cases of COPD

Objective To report the management of single allograft lung transplantation in 4 cases of COPD. Methods Four COPD cases receiving lung transplantation were analyzed respectively. There was diffuse emphysema in double lung in one case and in the remaining 3 cases severe diffuse emphysema that mixed together partially to be bulla but not to the 1/3 of the thoracic cavity. All the cases received the corpse donor. One case with diffuse emphysema received the single-right lung transplantation, one case received simultaneous single-lung transplantation and lung volume reduction and the remaining 2 cases received LVRS 47 days and 28 days after single-left lung transplantation respectively. The inductive treatment with the daclizumab or antithymocyte globulin (ATG) was done and the rejection was prevented with the Tacrolimus, mycophenolate and prednisone. Results The operations were successful in the 4 cases. One case had the acute rejection 5 days after operation and reco- vered after intensive treatment with Methylprednisolone. Two cases discharged successfully and lived to today and the first case lived more than 2 years. Two cases died 74 days and 77 days after lung transplantation respectively. Conclusion In late stage COPD, single allograft lung transplantation is an effective treatment to the bilateral emphysema patients and the lung volume reduction should be done simultaneously to the patients with the bullae that may be ruptured.