单肺移植结合对侧肺减容术治疗终末期肺气肿一例

目的　探讨单肺移植结合对侧肺减容术治疗终末期肺气肿的手术适应证及疗效。方法　对 1例呼吸机依赖的重症肺气肿、肺功能严重下降的 4 7岁患者行左肺移植。术后第 7天因患者对侧肺逐渐过度膨胀致纵隔左移 ,压迫移植肺 ,而行右侧胸腔镜辅助小切口肺减容术。结果　肺减容术后第 1天患者纵隔移位明显改善 ,移植肺扩张良好 ;术后第 9、15天移植肺 2次出现急性排斥反应 ,用免疫抑制剂治疗 ,并于术后第 15天行气管切开、呼吸机间断辅助呼吸 ,病情缓解 ;术后第 2 4天患者下床活动 ,第 2 6天拔除气管插管 ;术后 2个月检查患者肺功能明显改善 ;术后第 71天出院。结论　单肺移植结合对侧肺减容术能治疗重症肺气肿单肺移植后的对侧肺过度膨胀 ,明显改善肺功能。

Single-lung transplantation and contralateral lung volume reduction for emphysema

Objective To report the operation technique,patient selection and curative effect of single-lung transplantation with contralateral lung volume reduction for a patient with end-stage emphysema. Methods A 47-year-old male patient who was dependent on mechanical ventilation because of end-stage emphysema received left-lung transplantation on 20 Jun,2003.The surgical technique used was similar to that mentioned in the literature.The donor lung was perfused by low-potassium dextran solutions (LPD ) with a cold ischemic time of 390 minutes.The patient received contralateral lung volume reduction because of subacute native lung hyperinflation on the 7th day after operation.He was received tracheostomy on 15th day after operation and was weaned from ventilator on the 26th day post-operation.Immunosuppression included cyclosporine,mycophenolate mofetil and corticosteroid.The acute rejection occurred on the 9th and 15th days after operation and was cured successfully. Results The lung function was improved significantly and the patient was discharged from hospital 71 days after operation. Conclusions Single-lung transplantation combined with contralateral lung volume reduction for end-stage emphysema is an effective measure for subacute native lung hyperinflation.Further follow-up is required to assess the long term results of this procedure.