自体肺移植技术在Ⅲ期中心型肺癌外科治疗中的应用

Lung auto-transplantation technique in the treatment for stage Ⅲ central lung cancer

目的 探讨应用自体肺移植技术治疗Ⅲ期中心型肺癌的可行性.方法 从2000年8月至2007年6月,江苏省肿瘤医院胸外科共进行8例自体肺移植.所有8例患者术前均经纤支镜检查明确诊断,术前肺功能检查示不能耐受全肺切除术.术中下叶肺离体后以20℃含肝素生理盐水灌注,然后将下肺静脉重植于上肺静脉残端,依次完成支气管和肺动脉吻合.术中常规进行系统性淋巴结清扫.结果 8例患者术后均未发生支气管胸膜瘘.至2008年1月,6例患者已健康存活7～90个月,中位时间为33个月,生活质量良好.3例患者术后18、24及72个月的核素扫描娃示再植肺叶灌注良好.1例患者术后第2天因肺静脉栓塞接受再植肺叶切除术,并因肺癌复发于术后15个月死亡,另1例患者于术后31个月死于脑转移.结论 对于心肺功能不能耐受全肺切除的Ⅲ期中心型肺癌患者可考虑应用自体肺移植术,自体肺移植术是一种能保留健康肺组织的肺癌根治术.

Objective To assess the feasibility and benefit of lung auto-transplantation technique in surgical treatment for stage Ⅲ central lung cancer. Methods From Aug 2000 to June 2007 eight patients,who were proved to be malignant pathologically through fiber-bronchoscope before operations and could not tolerate pneumonectomy, underwent lung auto-transplantations. The ＂cutdown＂ lower lobe was flushed with heparin solution at 20℃. Since the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension-free anastomosis, we transplanted the inferior pulmonary vein to the proximal stump of the superior pulmonary vein. The bronchus and pulmonary artery were anastumosed in turn. Then radical hilar and mediastinal lymphadenectomy was performed. Results No anastomotie stoma fistula occurred inthese 8patients.Until Jan 2008,sixof theeightpatients who underwentlung autotransplantations, had been free of tumor recurrence for 7-90 months with good quality of life. And the median time was 33months. Radioisotope scanning of the replanted lobes of three patients revealed normal perfusion 18, 24 and 72 months postoperatively. One patient received resection of the replanted lobe because of pulmonary vein thrombus on the 2nd day after transplantation, and died of respiratory failure caused by pulmonary relapse on 15th month postoperatively.Another patient died of brain metastases 31 months postoperatively. Conclusion Lung auto-transplantationisanalternativetechnique for pulmonary preservation for patient with stage Ⅲ centrally placed lung cancer, whose cardio-pulmonary functions is too poor to undergo pneumonectomy.