右单肺移植治疗终末期肺气肿1例报告

目的 探讨单肺移植治疗终末期肺气肿的可行性,并总结术后处理体会. 方法 以低钾右旋糖酐液为肺保存液,采用顺灌结合逆灌的肺灌注方法,在非体外循环下为1例终末期肺气肿患者进行同种异体右肺移植术,术后采用新三联免疫抑制剂. 结果 术后移植肺再灌注损伤轻,43 h顺利脱离呼吸机;术后第6天发生1次急性排斥反应,甲基强的松龙冲击治疗后消退;术后移植肺感染轻,但自体左肺反复感染.术后73 d出院,肺功能改善明显,目前生存14个月,生活质量良好. 结论 单肺移植是治疗终末期肺气肿的有效手段,术前充分的准备和细心的围术期管理,特别注重单肺移植后自体肺感染的防治,是肺移植能否成功和长期存活的关键.

Right-Lung Transplantation for End-Stage Pulmonary Emphysema

Objective To report a case of right single-lung transplantation in an end-stage pulmonary emphysema.To evaluate the operative feasibility and postoperative management.Methods A(47-years)-old patient with end-stage emphysema underwent right-lung transplantation in June,2005.The donor lung was double direction perfusion with LPD solution with a cold ischemic time of 200 minutes.Cardiopulmonary bypass was not performed.The patients were treated postoperatively with new ternate immunosuppression regimen.Results The patient get off ventilator at the 43th hour after operation.Acute rejection occurred on the sixth day after operation and was cured by methylprednisolone given intravenously.The transplanted lung had mild ischemia-reperfusion injury and infection.Lung function was improved significantly and the patient was discharged from the hospital on the 73 th day after operation.The patient has been living for 14 months with wonderful life quality.Conclusion Single-lung transplantation for patients with end-stage pulmonary emphysema is effective for long-term improvement of pulmonary function.The success was chiefly ascribed to sufficient preoperative preparation and thoughtful postoperation management,especially the prevention and cure of self lung infection.