65岁以上终末期肺病患者肺移植疗效及预后分析

Curative effect and prognosis analysis of lung transplantation for patients over 65 years old with endstage lung diseases

目的探讨65岁以上终末期肺病患者肺移植的疗效及预后。方法回顾性分析2002年9月至2011年12月南京医科大学附属无锡市人民医院收治的24例老年(≥65岁)肺移植病例的临床资料。了解老年肺移植患者的存活情况,比较单肺和双肺移植的存活情况;了解肺移植术后并发症及对随访期内死亡的病例进行死因分析。结果所有患者肺移植手术均顺利完成。24例受者术后1、3、5、7年累积存活率分别为75.0%、62.5%、33.3%和12.5%,其中单肺移植患者相应为68.8%、50.0%、31.3%和12.5%,双肺移植患者相应为87.5%、87.5%、37.5%和12.5%。单肺与双肺移植患者中位生存时间分别为35、51个月,两组生存期比较差异无统计学意义(P>0.05)。感染是术后最主要的并发症,发生率为46%(11/24)。术后长期随访中17例死亡,包括重症感染9例,原发性移植物失功(PGD)1例,急性排斥反应(AR)1例,闭塞性细支气管炎(BOS)4例,心力衰竭1例,肿瘤1例。结论单肺或双肺移植均是治疗老年终末期肺病的有效方法,感染是老年受者术后最主要的并发症和死亡原因。

Objective To investigate the curative effect and prognosis of lung transplantation for patients over 65 years old with end-stage lung diseases.Methods Clinical data of 24 elderly patients （≥65 years old）undergoing lung transplantation in Affiliated Wuxi People＇s Hospital of Nanjing Medical University from September 2002 to December 201 1 were retrospectively analyzed.The survival conditions of elderly patients undergoing lung transplantation were studied and the survival conditions of unilateral lung transplantation and bilateral lung transplantation were compared.The complications after lung transplantation were observed and the death causes of patients died during the follow-up period was analyzed.Results All patients completed the lung transplantation successfully.The 1 ,3,5 and 7-year cumulative survival rate of the 24 patients were respectively 75.0%,62.5%,33.3% and 1 2.5%,and those of patients undergoing unilateral lung transplantation were respectively 68.8%,50.0%,31 .3% and 1 2.5% and those of the patients undergoing bilateral lung transplantation were respectively 87.5%,87.5%,37.5% and 1 2.5%.The median survival time of the patients undergoing unilateral lung transplantation and bilateral lung transplantation was respectively 35 months and 51 months,and there was no significant difference （P 〉0.05 ）.The primary postoperative complication was infection with the incidence of 46% （1 1 /24）.Seventeen patients died during the long-term follow-up.Among them,9 died of severe infection,1 died of primary graft dysfunction （PGD）, 1 died of acute rejection （AR）,4 died of bronchiolitis obliterans syndrome （BOS）,1 died of heart failure and 1 died of tumor.Conclusions Unilateral lung transplantation and bilateral lung transplantation are both effective methods to treat elderly patients with end-stage lung diseases.Infection is the primary postoperative complication and the cause of death of elderly patients.