右肺移植同期左肺减容术治疗终末期肺气肿的报告

A case of single lung transplantation and contralateral lung volume reduction surgery homochronously for end-stage pulmonary diseases

目的 探讨人体单肺移植同期行对侧肺减容术(LVRS)在治疗慢性阻塞性肺气肿(COPD)中的治疗效果及经验。方法 供体:脑死亡患者,使用改良的4℃LPD肺保护液,顺行灌注后再逆行灌注,肺膨胀状态下取下整体肺块无菌冷保护下送受体手术室,解剖修整后取右肺供移植用。受体:终末期双侧COPD ,右侧重于左侧,切除右全肺,适当保留右主支气管、右肺动脉及右肺静脉心房袖供吻合,将供体右肺移植于受体右胸腔内,再作左肺上叶减容术,减容达左肺2 5 %。结果 手术经过顺利,移植肺成活,无急性排异反应。左肺减容侧因术后胸腔内活动性渗血再次开胸。患者肺功能恢复满意,已长期存活。结论 使用改良LPD液顺灌及逆灌供肺对保护其功能及减轻排异反应有明显的效果,气管套叠式吻合及吻合口周围使用生物蛋白胶对减轻支气管吻合口并发症有益。单肺移植同时进行另一侧肺减容对患者术后肺功能的改善有明显作用。

Objective To explore the treatment effects of single lung transplantation and contralateral lung volume reduction surgery (LVRS) in the treatment of COPD. Methods Right single lung transplantation and left LVRS with video assisted thoracic surgery (VATS) were performed on a 45-year-old male patient with end-stage chronic obstructive pulmonary diseases (COPD). Results The operating procedure was performed successfully with the donor lung being alive, and no acute-rejection was seen. Re-exploration was made for progressive bleeding in left lung with LVRS on post-operation Day 1. The patient recovered well 4 months after the operation and was able to undertake light physical labour. The patient’s lung function recovered satisfactorily. Conclusion Single lung transplantation and contralateral LVRS stimultaneously have obvious effects on lung function’s improvement for postoperative patients.