非体外循环下序贯式双侧单肺移植治疗终末期肺气肿

Sequential bilateral single-lung transplantation for end-stage emphysema without cardiopulmonary bypass

目的 探讨非体外循环下序贯式双侧单肺移植治疗终末期肺气肿的可行性及手术技术。方法 2 0 0 4年12月2 8日为1例肺功能重度低下且呼吸机依赖的终末期肺气肿病人进行了非体外循环下序贯式双侧单肺移植。结果 术后10 6h脱机,术后第15d发生1次急性排斥反应,经大剂量甲基强的松龙冲击治疗后症状消退。术后2 8d胸部CT显示两肺扩张、血液灌注良好,左侧胸腔少量包裹性积液。病人术后肺功能明显改善,第4 1d出院。结论 非体外循环下序贯式双侧单肺移植治疗终末期肺气肿是可行的,该方法可和单肺移植一样在我国得以普及。

Objective To discuss operative technique, possibility of sequential bilateraU single-lung transplantation for endstage emphysema without cardiopulmonary bypass. Methods A 56-year-old male with end-stage emphysema was received a sequentia bilatemll single-lung transplantation without catdiopolmonary bypass in our hospital on 28 Dec. 2004. The surgical technique used was similar to that mentioned in the literature. The donor lung was perfused by Raffinose-LPD solution with a cold ischemic time of 3 hours and 15 minutes , 7 hours and 45 minutes. Results The patient weaned from ventilator at 106 hours postoperatively. Immunosuppression included cyclosporine, mycopheanlate mefetil and corticostemid. The acute rejection occurred 15th postoperative days and cured by bolus methylprednisolone given intravenously. His lung function was improved significantly and he was discharged from hospital 41 days after operation. Conclusion Sequentia bilaterall single-lung transplantation for end-stage emphysema without cardiopulmonary bypass is a safety method and it should be advocated in our country as single transplantation.