肺移植与大容量全肺灌洗治疗终末期尘肺效果比较

Comparing the therapeutic effect of lung transplantation with the therapeutic effect of whole lunglavage for the patients with end-stage pneumoconiosis

目的 探讨肺移植（LTx）与大容量全帅灌洗（WLL）治疗终未期尘肺的疗效。方法2002年6月至2011年2月对5例尘肺患者进行LTx治疗，12例进行单忡WLL，对接受不同治疗患者的临床症状、肺功能、肺动脉压力、血气、影像学检查、术后生存情况进行州顾性分析。结果 LTx组患者治疗后咳嗽、胸闷等症状得到明显改善，肺功能、m气分析较术前明显改善，肺动脉压力下降至IF常水平，胸部影像学检查显示移植肺扩张良好、肺纹理清晰，但长期随访后，移植对侧肺有影像学病变进展。WLL治疗后患者症状改善，但症状缓解程度随时间逐步下降，WLL治疗后半年内患肯怖功能得到改善，术后1年肺功能与术前相仿，术后2年肺功能明显下降，患者肺动脉压力较术前普遍升高，胸部影像学检查治疗后半年内无明显进展，但术后1～2年有明显的影像学病变进展。随访至今，LTx组甲均生存时间为40.5个月，WLL组为21.4个月。LTX组1例术后死于原发性移植物失功（PGD）引起的多脏器功能衰竭（MODS），1例术后7个月死于肺部感染，另3例现已分别存活65、41、29个月。WLL组患者术后7例死亡，死亡原闪为肺部感染3例，呼口及衰竭2例，心力哀竭1例，脑血管意外1例，平均生存时问为（19.0±8.7）个月，另5例现分别仔活7、9、13、18、26个月。结论 LTx围术期死亡风险大，术后可长期存活，生存质量良好。WLL能暂时缓斛患者的症状，改善肺功能，但长期生存较差。

Objective To explore the therapeutic effects of lung transplantation （LTx） and whole lung lavage （WLL） for patients with end-stage pneumoconiosis. Methods From June 2002 to Fehrua2011, 5 cases with end-stage pneumoconiosis were treated with LTx and 12 cases with end-stage pnemuoconiosis were treated with WLI,. The clinical symptoms, puhnonary functions, pulmonapy arlery pressures, hlood gas analysis, imagings of chest and survival status were retrospectively analyzed. Results In LTx group, the clinical symp- toms （cough, sense of suppression in the chest）, puhnonary functions and blood gas imticators were improved, pulmonary artery pressures decreased to normal levels, the imaging of chest showed that the implanted lung in- flated well and was with clear lung markings. But the contralateral lungs without treatment appeared the progres- sion of disease in the imaging of chest. In WLL group, the clinical symptoms in a half year after treatment were improved but the symptomatic relief rate declined with time, the pulmonary fimetions in half year after treatment were improved hut decreased after 2 years, the pulmonary artery hypertension enhanced generally, as compared with that prior to WLL. The disease progression in the ehest imaging examination was not found in a half year after WLL, but appeared in 1-2 years after WLL. During tollowing-up, the mean survival times in LTx and WLI~ groups were 40.5 and 21.4 months, respectively. In LTx group, one patient died of muhiple organ dysfunctions （MODS） caused by primary graft dysfunction （PGD）, one ease died of severe infection in seven mouths after LTx. Up to now, other 3 cases have survived for 65, 41 and 29 months, respectively. In WLL group, 3 cases （lied of I）ulmona inion, 2 cases （tied of respiratoy tiailure, one case died of heart failure and one case died of en- eephahm vascular accident, the mean survival time of these 7 patients was （19.0±8.7） nmnths. So far other 5 cases have survived for 7, 9, 13, 18 and 26 months, respectively. Conclusion LTx has greater risk of death during preoperative period, but patients after l,Tx may have long survival times with good quality of life. The cliniealsymptoms and pulmonary functions of patients can be improved temporarily after WLL, but the survival time of WLL is inferior to that of I,Tx.