肺移植治疗肺纤维化10例临床分析

Lung transplantation for pulmonary fibrosis:report of 10 cases

目的探讨肺移植治疗肺纤维化的手术适应证、围手术期的处理及疗效。方法 2002年9月至2005年12月无锡市胸科医院采用肺移植治疗肺纤维化10例,包括特发性肺问质纤维化9例、术前长期依赖呼吸机(150 d)的重症肺炎后肺纤维化1例。手术方式均为单肺移植,其中2例在体外循环下进行,有1例为左侧供肺植入右胸腔。结果术后1例于137 d 死于重症肺部感染合并急性呼吸窘迫综合征,其余9例患者痊愈出院,平均术后住院时间为44 d。随访中1例术后9个月死于肺部感染,1例术后25个月溺水意外死亡,其余7例均健在,且肺功能有极大的改善。结论单肺移植是治疗特发性肺间质纤维化的有效方法。

Objective To discuss the operative technique, patient selection and perioperative management of lung transplantation for pulmonary fibrosis. Methods From September 2002 to December 2005, 31 cases of lung transplantations were performed in our hospital. There were 10 cases receiving single lung transplantation for pulmonary fibrosis, among them 2 received fight lung transplantation with cardio pulmonary bypass, and one received contralateral lung transplantation- a left donor lung implanted in the recipient＇s fight thorax. Results The in-hospital mortality was 10. 0% （1/10）. Nine patients were discharged from hospital , while one patient died of severe infection on the 137th postoperative day. During follow-up, one patient died of infection 9 months and another patient died of an accident 25 months after the operation. The 7 other patients were alive with improved lung functions. Conclusion Lung transplantation is effective in improving the survival of selected patients with idiopathic pulmonary fibrosis.