单肺移植术治疗终末期肺疾病11例

Single lung transplantation for end-stage pulmonary disease

目的总结单肺移植治疗终末期肺病的早期临床结果和经验。方法2003年1月至2005年9月,为11例终末期肺疾病患者施行了单肺移植术,其中右侧单肺移植7例,左侧单肺移植4例。有2例受者接受同一供者的左、右肺。结果目前有6例单肺移植受者术后生存1年以上,其中3例存活2年以上;3例存活6个月以上。9例存活的受者生活均能自理,活动良好。术后2个月肺功能复查:动脉血氧分压(PaO2)均>80mm Hg,较术前提高37.6%;有8例受者第1秒用力呼气量(FEV1)较术前提高165.2%。2例死亡的受者中,1例因术中大出血死亡;1例淋巴管平滑肌瘤受者术后3个月后死于顽固性乳糜胸。受者术后急性排斥反应平均发生率为1.2次;4例术后并发曲霉菌感染;3例术后出现支气管狭窄;2例术后并发严重肺部感染;1例术后36h出现缺血/再灌注损伤;1例术后7d并发胃底黏膜撕脱继发上消化道大出血;1例术后1年出现慢性排斥反应。结论单肺移植是治疗终末期肺疾病的有效方法。肺移植术后并发症发生率高,应进行有效的预防和治疗。

Objective To summarize the initial outcome of single lung transplantation in the treatment of end-stage pulmonary disease. Methods From Jan. 2003 to June 2005, 11 cases were subjected to single lung transplantation consecutively at our hospital. Of the 11 patients with end-stage pulmonary diseases, 7 underwent the right single lung transplantation, and 4 the left procedure. Among them, 2 patients received single lung transplantations by the same donor. Results Of the 11 patients, 6 cases have been alive for more than 1 year （including 3 cases been alive for more than 2 years）. Three cases have been alive for more than 6 months. Lung function examination was done 2 months after lung transplantation. Nine patients showed normal PaO2 values （more than 80 mm Hg） with an average improvement of 37. 6%, and 8 obtained an average improvement of 165.2% in FEV1. One case died of bleeding intra-operatively. One case died of chylothorax at 3rd month post-operatively. 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 cases, reperfusion-injury-induced pulmonary edema in 1 case at 36th h postoperatively, and upper alimentary canal hemorrhage in 1 case at 7th day. Chronic rejection occurred in 1 case at first year postoperatively. Conclusions Single lung transplantation is effective in treating end-stage pulmonary disease. The incidence of complication was higher after lung transplantation. Effective prevention and management should be emphasized.