终末期肺气肿肺移植治疗术式的选择

The operative technique selection of lung transplantation for end-stage emphysema

目的探讨终末期肺气肿患者行肺移植手术方式的选择.方法自2002年9月至2005年2月为9例终末期肺气肿患者施行左侧单肺移植1例、右侧单肺移植1例、左单肺移植+术后1周对侧肺减容术1例、左单肺移植+同期对侧肺减容术2例、右单肺移植+同期对侧肺减容术2例、非体外循环下序贯双肺移植2例.结果术后1 d内2例胸腔引流量超过2000 ml,1例再次开胸止血,1例保守治疗控制.术后机械通气3～22 d,其中2例行气管切开.7例至今存活良好,均能生活自理,其中2例已恢复工作,目前存活最长时间30个月.1例因重症急性排斥(4A级)于术后15 d死亡,1例因余肺重症细菌感染合并霉菌感染于术后1个月因多脏器衰竭死亡.结论单肺移植可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地利用供体,避免对侧自体肺过度膨胀等术后并发症.对存在感染的终末期肺气肿患者应首选双肺移植.

Objective To investigate the operation of lung transplantation for end-stage emphysema. Methods From September 2002 to February 2005, 9 patients with chronic obstructive pulmonary disease （COPD） underwent lung transplantation. The types of surgery included single lung transplantation in 2 patients, lung transplantation with asynchronous contralateral lung volume reduction（ one week later） in 1, single lung transplantation with synchronized contralateral lung volume reduction in 4, and bilateral sequential lung transplantation without cardiopulmonary bypass in 2. Results The volume of chest drainage was more than 2000 ml at the first postoperative day in 2 aptients, one was reoperated for hemostasis and another was successfully responded to conservative therapy. The ventilation time was ranged from 3 to 22 days postoperatively. Two patients were received tracheotomy. Seven patients achieved good results, two of them had returned to work , and 1 patient had lived for 30 months. One patient was died of severe acute rejection（4A） at 15th postoperative day and l succumbed to muhisystem organ failure due to severe bacterial infection combine fungal infection. Conclusion End-stage emphysema is an indication for single lung transplantation. Single lung transplantation with contralateral lung volume reduction is a good way to utilize donor. If patient suffered from infection, double-lung transplantation should be considered first .