肺移植术后肺癌1例报告并文献复习

Bronchogenic Carcinoma after Lung Transplantation:A Case Report and Literature Review

背景与目的肺移植是治疗终末期肺部疾病的有效手段,然而对肺移植术后肺癌却缺乏了解。我们通过对1例肺移植术后肺癌患者临床资料的报道,并结合相关文献复习,以提高对肺移植术后肺癌的认识、诊断及治疗水平。方法 2007年5月我院为一例65岁、术前诊断为两肺特发性肺间质纤维化(idiopathic pulmonary fibrosis,IPF)的男性患者在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助下成功进行了右侧单肺移植,患者术后46d恢复良好出院。术后免疫抑制方案为他克莫司(Tac)+吗替麦考酚酯(骁悉)+类固醇激素。出院后患者定期随访。结果在移植术后13个月随访确诊为非移植侧左肺小细胞肺癌伴多发骨转移。患者给予依托泊苷联合顺铂(EP方案)化疗4次症状有所缓解,患者在诊断肺癌后11个月死亡。结论肺移植术后肺癌严重影响移植患者远期存活,慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)、IPF、吸烟史及免疫抑制剂等为其危险因素,为改善预后,需要早期诊断及早期治疗。

Background and objective Lung transplantation is an efficient therapeutic option for patients with end-stage pulmonary diseases, but less is known about lung cancer after lung transplantation. The aim of this study is to improve the awareness, diagnosis and treatment of bronchogenic carcinoma after lung transplantation with a case report and related literatures. Methods We reported a 65-year-old male with idiopathic pulmonary fibrosis （IPF） who underwent right lung transplantation under extracorporeal membrane oxygenation （ECMO） support in May 2007 in our hospital. The patient recovered smoothly and discharged from the hospital 46 days after the procedure with regular follow-up. Immunosuppression therapy was triple drug maintenance regimen including tacrolimus （Tac）, mycophenolate mofetil （MMF） and steroids. Results Small cell lung cancer in the left lung with multiple osseous metastases was found 13 months after the lung transplantation. Symptoms were relieved a bit by administering chemotherapeutics （etoposide and cisplatin） for 4 cycles. However, the patient was succumbed to his illness within 11 months after the diagnosis of lung cancer. Conclusion Lung cancer after lung transplantation has been suggested as one of causes of late mortality with the risk factors such as chronic obstructive pulmonary disease （COPD）, IPF, cigarette smoking history and immunosuppression etc. Early diagnosis and treatment are very important to improve the prognosis.