单肺移植治疗终末期慢性阻塞性肺疾病患者单中心经验

目的探讨单肺移植治疗终末期慢性阻塞性肺疾病（COPD）患者的疗效、预后相关因素及术后并发症防治。方法回顾性分析同济大学附属上海市肺科医院2003年1月至2011年2月施行的23例终末期COPD患者单肺移植的临床资料,分析术后临床疗效、预后和并发症发生情况,并探讨性别、年龄、原发病等因素对受者预后的影响。结果 COPD患者术后肺通气功能和动脉血气分析结果均明显改善。气管吻合口并发症发生率为13.0%;围手术期病死率为4.3%。术后肺部真菌感染发生率为39.1%,伊曲康唑或卡泊芬净＋两性霉素B预防性抗真菌治疗的受者术后真菌感染的发生率明显降低（P=0.035）。急性排斥反应发生率为34.8%,闭塞性细支气管炎发生率为26.1%。受者术后1、3和5年存活率分别为83%、66%和45%。单肺再次移植2例。结论单肺移植治疗终末期COPD是安全、有效的方法,受者选择和术后并发症的防治对受者长期生存有重要意义。

Outcomes of single lung transplantation in 23 patients with end- stage chronic obstructive pulmonary disease:a single center 8- year experience

Objective To investigate the efficacy, prognostic factors and complications of single lung transplantation for chronic obstructive pulmonary disease （COPD） at a single center. Methods A retrospective analysis of demographic and outcome data for 23 patients with end-stage COPD undergoing single lung transplantation consecutively between January 2003 and February 2011 was performed. Survival analyses were performed using Kaplan-Meier estimation. Results Pulmonary function and blood gas were improved in all 23 patients after transplantation. Three patients （ 13.0% ） had airway complications. One patient died within 30 days after operation. Nine patients developed fungal infection （39.1% ）. Patients pretreated with itraconazole or caspofungin plus amphotericin B had lower fungal infection rate （P =0.035）. Eight patients （34.8%） had at least 1 episode of acute rejection within the first year, and 26.1% of the patients had bronchiolitis obliterans syndrome. The survivals at 1, 3, and 5 years were 83%, 66%, and 45%, respectively. Two patients underwent single lung retransplantation. Conclusion Single lung transplant may offer acceptable early survival for patients with end-stage COPD. Patient selec- tion criteria and prophylaxes of complications are important to improve the long-term survival of COPD patients after lung transplantation.