肺移植治疗终末期肺病18例报告

Lung transplantation for end-stage pulmonary diseases: report of 18 cases

陈静瑜郑明峰朱艳红胡春晓何毅军王永功周敏陆国础陆明华【摘要】目的探讨国内开展临床肺移植的可行性以及目前存在的主要问题。方法2002年9月至2005年4月共完成临床肺移植18例,其中肺气肿9例、肺纤维化5例、矽肺1例、支气管肺扩张1例、肺淋巴管平滑肌瘤病1例及室间隔缺损合并艾森曼格综合征1例。受者术前均为重症呼吸衰竭,长期靠呼吸机依赖3例。手术方式为:单肺移植15例(左肺移植9例,右肺移植6例),其中2例受者的供肺为同一供者同期的左、右单肺,有1例为左侧供肺植入右胸腔,1例为体外循环下室间隔缺损修补后行右肺移植;非体外循环下序贯式双侧单肺移植3例。结果术后短期内死亡3例,1例于术后15d死于急性排斥,1例于术后30d死于感染后多脏器功能衰竭,1例术后36d死于肺梗死。其余15例均痊愈出院,肺功能明显改善,生存1年以上3例,生存2年以上2例,中位生存时间10个月。结论肺移植是治疗各种终末期肺病的有效的手段;但术后的缺血再灌注损伤、排斥反应和感染仍是肺移植短期死亡的主要原因。

Objective To discuss the feasibility of the lung transplantation as an effective treatment for end-stage pulmonary diseases domestically and to compare the major issues involving the practice of lung transplantation domestically and overseas. Methods After the foundation of group of lung transplantation in May 2002, lung transplantation models of porcine were set up. From September 2002 to April 2005, in the 18 cases undergoing lung transplantation, there were subjected to single-lung transplantion （SLT, 83.3%） and 3 bilateral sequential single lung transplants without CPB （DSSLT, 16. 7%）. Indications for SLT （n = 15） included emphysema （n = 9）, pulmonary fibrosis （n = 3）, pneumosilicosis （n = 1 ）, lymphangioleiomyomatosis （n = 1 ） and ventricular septal defect （VSD） induced Eisenrnenger＇s syndrome （ n = 1 ） ; for DSSLT （ n = 3 ） bronchiectasis （ n = 1 ） and pulmonary emphysema （n = 2）. Among the 15 SLTs, there were 9 cases of left SLT and 6 right SLT. Among them, 2 cases shared one same donor＇s lung block, one case received contralateral lung transplantation — a left donor lung implanted in the recipient＇s right thorax, and one case simultaneous right SLT and VSD repair. Results In hospital mortality （HM） was 3/18 （16. 7 % ）. Among SLTs, early death was due to severe rejection on the 30th postoperative day in one patient and acute rejection on the 15th postoperative day in other patients, and another patient died due to pulmonary vein embolism on the 36th day. There were 3 and 2 patients with the survival time longer than 1 and 2 years respectively. The median overall survival was 10 （2 to 32） months. Conclusions Our LT program shows similar results to those reported by the International Society for Heart and Lung Transplantation for developed countries. The key of successful operation depends on the establishment of group of lung transplantation and cooperation of multi-department. Ischemic-reperfusion injury, acute-rejection and infection are the major reasons of deaths shortly after the operations.