单肺移植同期对侧肺减容术治疗终末期肺气肿

Single lung transplantation with concomitant contralateral lung volume reduction for end-stage emphysema

目的探讨单肺移植同期对侧肺减容术治疗终末期肺气肿的疗效。方法对1例46岁终末期肺气肿患者同期行右侧单肺移植和左侧肺减容术。结果患者术后恢复顺利,减容侧肺无明显膨胀,纵隔无移位,移植肺无受压,扩张良好。患者术后无明显排斥反应,术后60h拔气管插管,108h脱离呼吸机,7d下床活动,45d出院。术后减容侧出现轻度胸腔漏气,胸腔内注入高渗糖数次后治愈。术后肺功能较术前显著改善。结论单肺移植同期对侧肺减容术治疗终末期肺气肿可避免因单肺移植后导致对侧气肿肺过度膨胀,压迫移植侧肺,从而影响移植肺的功能和血流动力学稳定性等问题,提高肺移植的成功率。

Objective To evaluate the effect of single lung transplantation with concomitant contralateral lung volume reduction surgery （LVRS） for the management of end-stage emphysema. Methods A 46 year-old patient with end-stage emphysema received fight lung transplantation and LVRS through the bilateral anterior-lateral intercostal incisions simultaneously. Results Hyperinflation of the native lung or mediastinal shift did not occur after the operation, and the transplanted right lung dilated well without suppression. Acute rejection was not observed and the patient weaned from tracheal intubation 60 h after operation and from ventilator 108 h postoperatively. Persistent air leak occurred after LVRS but closed after instillation of hyperosmotic glucose. The patient was discharged 45 days after operation with significantly improved pulmonary function and normal life. Conclusion Single lung transplantation with concomitant contralateral lung volume reduction for emphysema eliminates such complications of single lung transplantation as native lung hyperinflation, mediastinal shift, excessive suppression of the transplanted lung and hemodynamics instability, and can improve the success rate of the operation.