双肺移植治疗骨髓移植术后闭塞性细支气管炎一例报告并文献复习

Bilateral lung transplantation for bronchiolitis obliterans after allogeneic bone marrow transplantation： a case report and literature review

目的探讨肺移植治疗骨髓移植（BMT）术后闭塞性细支气管炎（BO）的可行性及疗效。方法报告1例双肺移植治疗BMT术后BO患者的诊治经过，并进行相关文献复习。结果23岁男性BMT术后BO患者接受非体外循环下双侧前外侧切口不横断胸骨序贯式双肺移植术，术后第2天发生急性排斥，予机械辅助通气、激素冲击、丙种球蛋白封闭抗体等治疗好转，术后两周转出ICU，43d出院，术后3、6个月随访复查CT、肺功能，恢复良好。结论BO是BMT术后晚期常见非感染性肺部并发症之一，对于其中药物治疗无反应患者，肺移植是目前唯一的有效治疗手段，可有效提高患者生存期及生活质量。然而目前肺移植治疗BMT术后BO的样本量尚小，还需要多中心、大样本的临床研究来分析手术时机的选择、术后并发症的处理。

Objective To explore the feasibility and efficiency of lung transplantation in the treatment of bronchiolitis obliterans （BO） after allogeneic bone marrow transplantation （allo-BMT）. Methods We reported one case of bilateral lung transplantation for BO after allo-BMT and reviewed the related literatures. Results A 23 year-old man diagnosed as BO after allo-BMT underwent a sequential bilateral lung transplantation through bilateral anterolateral thoracotomy without sternal division. The patient suffered from acute rejection on post-operation day （POD） 2, and cured by mechanical ventilation, large dose of methylprednisolone and gamma globulin. The patient was transferred out of the intensive care unit on POD 14 and discharged from the hospital on POD 43. Chest CT scans and pulmonary function tests showed good performance in 3 and 6 months follow-up period. Conclusion BO is one of the late common non-infectious pulmonary complication after allo-BMT. For patients who have no response to medication, lung transplantation is the only efficient treatment choice so far, which can prolong survival and improve the quality of life. However, limited by small samples, optimal surgery time and appropriate care of postoperative complications still need accumulation of experience by multicenter and large samples studies.