肺移植治疗终末期肺病临床研究

Three Year’s Experience of Lung Transplantation for End-stage Pulmonary Disease.

目的对比国外开展肺移植情况，探讨临床肺移植在我国开展的可行性，目前主要存在的问题及对策。方法2002年5月，我院成立肺移植团队，开展猪肺移植动物实验，在此基础上于2002年9月-2005年8月我院共完成临床肺移植24例，其中肺气肿11例、肺纤维化8例、硅沉着病1例、双侧支气管肺囊肿2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。受体术前均为重症呼吸衰竭，长期靠呼吸机依赖4例。手术方式：单肺移植20例，包括：左肺移植11例，右肺移植9例，其中2例为同一供体同期的左、右单肺移植，有1例为左侧供肺植入右胸腔，1例为体外循环下室缺修补后行右肺移植，1例为体外循环下右肺移植；双肺移植4例，包括非体外循环下序贯式双侧单肺移植3例，体外循环下序贯式双侧单肺移植1例。结果术后短期内死亡5例，其中1例于术后15天死于急性排斥，2例于术后30天死于感染、多脏器衰竭，1例术后36天死于肺梗死、1例术后1天死于心脏衰竭。19例痊愈出院，术后早期生存率79．8％（19／24），肺功能极大改善，生存3年以上1例，生存2年以上2例，1年以上1例，中位生存时间10（1—36）个月。结论本组肺移植的结果与国际发达国家的疗效相似，肺移植在我国新世纪会迎来一个快速发展阶段，组建肺移植团队、多学科合作是肺移植手术成功开展，术后长期生存的关键；术后的缺血再灌注损伤、排斥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 disease domestically. 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, we have set up lung transplantation models of porcine. From September. 2002 to August 2005, the 24 LT that were performed included 20 single - lung transplants SLT （ 83.3% ） and 4 Bilateral sequential single lung transplants （BSSLT） （16.7%） ,among them only one case receive BSSLTx with CPB. Indications for SLT （n = 20） , emphysema （n = 9 ） , pulmonary fibrosis （ n = 8 ） , pneumosilicosis （ n = 1 ） , lymphangioleiomyomatosis （ n = 1 ） and ventricular septal defect （ VSD ） induced Eisenmenger＇s syndrome （ n = 1 ） ; for BSSLT （ n = 4） were bronchiectasis （ n = 2 ） and pulmonary emphysema （ n = 2 ）. 20 SLTs include 11 left single lung transplantation and 9 right lung transplantation. Among them, 2 cases share one same donor＇ s lung block, one case of contralateral lung transplantation - a left donor lung implanted in the recipient＇ s right thorax, one cases of simultaneous right single lung transplantation and ventricular septal defect repair. One case receive right single lung transplantation with CPB. Results In - hospital mortality （ HM ） was 5/24 （20.2%）. Among SLT, early death was due to severe infection on the 30th postoperative day in two 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. The patient who is received BSSLTx with CPB died because of acute heart failure. And The patients survived longer than1,2,3 years were 1, 2,1 cases respectively. The median overall survival was 10 （1 to 36） months. Conclusions Our LT program shows similar results to those reported by the International Society for Heart and Lung Transplantation for developed countries. A rapid development era of lung transplantation is emerging in China. 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.