65例肺移植手术的临床分析

The Clinical Analysis of 65 Cases with Lung Transplantation

目的探讨肺移植术中供者肺的获取和术中可能遇到的特殊情况处理,以提高肺移植手术的成功率。方法65例重症呼吸衰竭,其中长期依赖呼吸机9例;病种包括肺气肿23例,肺纤维化24例,矽肺5例,肺结核2例,肺淋巴管平滑肌瘤病1例,室间隔缺损合并艾森曼格综合征4例,支气管肺囊肿4例,弥漫性细支气管炎1例和原发性肺动脉高压1例。行单肺移植术47例,双肺移植术18例。回顾性总结肺移植手术的临床经验,特别是手术中遇到的特殊情况的处理经验。结果64例供肺均获取成功。肺移植术后住院死亡11例（16.9%）,其中原发性移植肺失功3例,严重感染6例,急性排斥反应1例,肺梗死1例。术后发生并发症9例,包括术后渗血多二次开胸止血3例,肺动脉狭窄二次手术重新吻合纠正1例,支气管吻合口狭窄3例;肺梗死2例,其中1例肺叶梗死患者二次开胸手术切除。随访54例,随访时间1.0~5.6年,1年生存率达72.3%（47/65）,大部分患者生活质量良好,肺功能有极大的改善。结论提高供肺获取和受者肺移植手术技术有助于降低肺移植手术后的早期死亡率。

Objective To investigate the experience of operative technique of donor organ harvesting and lung transplantation in some unusual circumstance, and to improve surgical success ratio of lung transplantation. Methods Lung transplants were preformed in 65 cases, including 47 single-lung transplants and 18 double single lung transplants. All the recipients were suffered from intensive respiratory failure, and nine patients were long-term ventilator-dependented of the total. The recipients included emphysema （n = 28）, pulmonary fibrosis （n = 24）, pneumosilicosis（n =5）, pulmonary tuberculosis（n = 2）, lymphangioleiomyomatosis（n = 1 ） and ventricular septal defect （VSD） or VSD with Eisenmenger＇ s syndrome （n = 4）, bronchiectasis （n = 4）, diffuse panbronchiolitis （n = 1） and primary pulmonary hypertension（n = 1）. Retrospectively summarize clinical experience of lung transplant operation especially experience of dealing with special circumstances encountered in operation. Results 64 donor organ harvesting were achieved successfully. In-hospital death was llcases （16.9 %） after operation. Early death was due to primary lung graft dysfunction （n= 3）, severe infection（n=6）, acute rejection（n= 1）, pulmonary vein embolism（n= 1）. Complications took place after operation in 9 cases, to exploratory thoracotomy to stop bleeding after transplantation in 3 cases, pulmonary artery anastomosis again because of stenosis in 1 case, bronchus stoma stenosis in 3 cases, pulmonary infarction in 2 cases, of which one patient accepted pulmonary lobectomy. Follow-up period was from 1.0 year to 5.6 years of 54 cases. 1-year survival rate was 72.3 % （47/65）. The pulmonary function was improved and the quality of life is well in most patients of the group. Conclusion To improve the technique of donor organ harvesting and lung transplantation is important to decrease the early mortality after transplantation.