单肺移植术治疗重度肺气肿

Single lung transplantation for severe pulmonary emphysema

目的总结单肺移植治疗重度肺气肿的早期临床结果和经验体会。方法 2003年1月至 2004年9月,6例重度肺气肿病人施行同种异体单肺移植术,其中右侧单肺移植4例,左侧单肺移植2 例。6例均为男性,年龄51-63岁,平均54．2岁。术前均有呼吸困难史5-23年,气急分级4级。术前肺功能检查示FEV1(0．69±0．36)L,占预计值(23．3±12．9)％。PaO2(62．5±6．5)mm Hg(1／mm Hg=0．133 kPa),PaCO2(41．4±14．9)mm Hg,6 min行走试验(6 MMT)为(51．5±18．0)m,术前平均肺动脉压(30±6) mm Hg。术后均采用三联免疫抑制剂。结果 4例术后并发曲霉菌感染,2例术后并发严重肺部感染,1 例术后36 h出现再灌注性肺水肿,1例术后7 d并发上消化道大出血。6例术后分别已生存24、19、14、 10、9、4个月,目前生活自理,活动良好。术后2个月复查,PaO2均>80 mm Hg,较术前提高37．6％,除1 例外,FEV1较术前提高165．2％。术后急性排斥反应平均发生1．2次。结论单肺移植是治疗终末期肺气肿的有效方法。

Objective To summarize the initial outcome on the treatment of severe pulmonary emphysema by single lung transplantation. Methods Between January 2003 and September 2004, 6 single lung transplantations were conducted consecutively at our hospital. Of the 6 patients with severe pulmonary, emphysema, 4 underwent the fight single lung transplantation, and 2 the left procedure. All 6 patients were males with a mean age of 54.2 years （range： 51 - 63 years）, and suffered from severe dyspnea （Grade Ⅳ of the Hugh-Jones dyspnea scale） for 5 to 23 years before operation. Preoperative lung function showed an average FEV1 of （0.69 ± 0.36）L[ （23.3 ± 12.9） % of the predicted], PaO2 of （62.5 ± 6.5） mmHg, PaCO2 of （41.4 ± 14.9） mmHg, 6 MMT of （51.5 ± 18） m and a mean pulmonary arterial pressure （PAP） of （30 ± 6） mmHg. All patients were treated postoperatively with conventional temate regimen. Results All 6 patients remain alive and palmonary function were very well with post-operation survival of 24, 19, 14, 10, 9, 4 months, respectively. When assessed at 2 months after lung transplantation surgery, all 6 patients showed normal PaO-2 values （more than 80 mmHg） with an average improvement of 37.6%, and 5 FEV1 were improved significantly （165.2%） in 5 patients. The incidence of acute rejection was 1.2 averagely in this group. As to other complications, aspergillosis occurred in 4 cases, severe lung infection in 2, repeffusion pulmonary edema in 1 at 36th hour postoperatively, and upper alimentary canal hemorrhage in 1 on 7th day. Conclusion Single lung transplantation is effective in treating end-stage pulmonary emphysema.