23例次肺移植术后受者的临床分析

Mid-term results after lung transplantation in 23 consecutive recipients at a single center

目的评估23例次肺移植术后受者的临床预后情况。方法总结2003年1月至2007年8月施行的23例次（21例患者）肺移植的临床资料，分析存活率及并发症。结果肺移植围手术期死亡率为13％；术后3个月、1年、2年和3年的累积存活率分别为82．6％、82．6％、69．7％和58．1％。受者术后2个月时的通气和换气功能较术前明显改善（P〈0．05）。有10例受者术后6个月内出现轻度急性排斥反应，经激素冲击治疗后均缓解。4例受者分别于术后8个月、9个月、14个月和24个月时出现慢性排斥反应；术后6、12和24个月时未发生慢性排斥反应的受者分别为95％、78．2％和71．1％。术后肺部感染发生率为33．3％；气管吻合口软化和狭窄发生率为14．3％。结论肺移植术后受者的中期存活率较高；肺部感染和支气管吻合口软化及狭窄是肺移植术后主要并发症。

Objective To evaluate the complications and survival after lung transplantation in one center. Methods From January 2003 to August 2007, 23 patients with end-stage lung diseases received lung transplantations consecutively in our center. The clinical data of recipients＇ demographic data, survival, postoperative complications, pulmonary function, oxygenation, incidence of rejection, and pneumonia were analyzed retrospectively. Results Three patients （13%） died in the early postoperative period （1-30 days）. Cumulative survival rate was 82. 6 % at 3 months, 82. 6 % at 1 year, 69. 7% at 2 years, and 58.1 % at 3 years respectively. Of 21 recipients, 3 recipients developed pulmonary bacterium infection （14. 3 %）, 4 developed fungal infection （19 %）, and 3 had bronchus suture complications （14. 3 %）. There was significant difference in forced expiratory volume in one second [（FEV1 （ 19. 5 ± 4. 9） vs （44. 7 ± 17. 9）% of the predictive value], maximal ventilatory volume [MVV （23. 1± 5.7） vs （59.8± 18. 9）% of the predictive value], forced expiratory volume in one second/forced vital capacity （FEV1/FVC, 34. 9 ± 5.0 vs 64. 6 ± 16. 7）, arterial oxygen tension [PaO2 （59. 3 ± 8. 7） vs （83.6 ± 10. 6） mm Hg], and arterial carbon dioxide tension [PaCO2, （48. 1 ± 11.0） vs （38. 5 ± 3.9） mm Hg] at the 2nd month post-transplantation vs before operation （all P〈0. 01）. An average of 0. 48 episodes of acute rejection developed per patient in the first 6 months after lung transplantation. Freedom from bronchiolitis obliterans syndrome was 95%, 78. 2% and 71.1% at the 6th, 12th and 24th month posttransplantation, respectively. Conclusions The pulmonary functional status is improved significantly after lung transplantation. Mid-term survival was comparable to the data of the international society for heart and lung transplantation. The most frequent complications postoperation were pulmonary infection and bronchus suture.