肺移植治疗终末期肺气肿19例报告

目的 探讨肺移植治疗终末期肺气肿的手术适应证、术式的选择及术后疗效.方法 报告肺移植治疗终末期肺气肿19例,患者术前CT检查均以弥漫性肺气肿为主,均经2～3年不同程度的吸氧治疗,其中依赖呼吸机的有5例.手术方式分别为:单肺移植6例;单肺移植加对侧肺减容术7例;双肺移植6例.结合这19例患者的肺移植效果进行分析和总结.结果 单肺移植的受者中,术后第1天内有2例受者胸腔引流量超过2000 ml,再次剖胸探查止血.19例受者术后机械通气时间为3～22 d,平均呼吸机脱机时间为7 d.术后1个月内死亡5例,死亡原因分别为:原发性移植物功能丧失1例、支气管吻合口漏1例、重症急性排斥反应(4A级)1例及重症细菌和霉菌感染2例.6例双肺移植的受者术后早期均康复出院.19例患者术后1、2、3年存活率分别为73.7%、63.2%和52.6%.结论 肺移植是治疗终末期肺气肿最有效的方法;单肺移植口丁作为终末期肺气肿的常用术式,单肺移植结合对侧肺减容术可以更好的利用供肺,同时又解除了术后对侧自体肺的并发症;对年龄较轻及有双肺感染的终末期肺气肿患者,应首选双肺移植,双肺移植较单肺移植术后并发症更少.

Lung transplantation for end-stage emphysema:a report of 19 cases

Objective To discuss the selection of recipients,urgical technique and preoperative managements of lung transplantation for the patients with end-stage emphysema.Methods Nineteen patients with end-stage emphysema underwent lung transplantation.All the patients have been treated with oxygen therapy for 2 to 3 years,nd diffused emphysema was found by CT preoperatively in all patients.Five patients relied on meehanical ventilation before transplantation.Following surgical operations were performed:single-lung transplantation (SLT)(n=6),LT combined with contralateral lung volume reduction surgery (n=7),equential bilateral lung transplantation (SBLT) (n=6).Results Two patients underwent thoracotomy and hemostasis in the first day after transplantation because the liquid volume of chest drainage was more than 2000 ml.All the patients were subjected to mechanical ventilation for 3 to 22 days (average 7 days) after transplantation. In 5 deaths about one month after transplantation,he causes of death included primary graft dysfunction (PGD) (n=1),fistula of bronchi stoma (n=1),evere acute rejection (4A) (n=1),erious infection (n=2).Six patients undergoing bilateral lung transplantation discharged early after transplantation.The 1-,-and 3-year survival rate was 73.7%,3.2% and 52.6% respectively.Conclusions Lung transplantation is the most effective means to treat the patients with end-stage emphysema and single lung transplantation may become a routine.Single lung transplantation combined with contralateral lung volume reduction eliminates complications such as hyperdistension of contralateral lung after transplantation and utilizes the donor organs better.Bilateral lung transplantation is a primary choice for young people and the patients companied with bilateral pulmonary infection,ecause its complications is less than single lung transplantation.