上海市胸科医院肺移植10年经验总结

The 10-yeay experience of lung transplantation in Shanghai Chest Hospital

目的总结上海市胸科医院近10年肺移植手术和围术期处理的经验。方法回顾性分析2007年1月—2016年12月在上海市胸科医院进行的肺移植手术患者的临床资料,其中单肺移植6次(包括2例再移植,2例单侧肺叶移植),双肺移植24次。患者的基础疾病分别为特发性肺纤维化14例,慢性阻塞性肺疾病8例,弥漫性支气管扩张3例,肺移植术后闭塞性细支气管炎2例,肺泡细胞癌1例,肺淋巴管平滑肌瘤病1例,肺纤毛不动症1例。分析肺移植患者术后1、3、5年的累计生存率和术后主要死亡原因。结果肺移植术后90d内病死率为13.3%(4/30),其中2例(6.7%)死于术后30d内,主要死亡原因为循环衰竭和心力衰竭;另2例的主要死亡原因是脑血管意外和气道出血感染。1、3、5年的累计生存率分别为60%、50%和41%,随访3年内死亡的主要原因为肺部感染和吻合口并发症;3年后死亡的主要原因为闭塞性细支气管炎综合征。结论肺移植技术已经较为成熟,是一种治疗终末期良性肺病的有效手段。

ObjectiveTo share the experience of10years of perioperative management for lung transplantation.MethodsA retrospective study of transplantation cases from Jan2007to Dec2016in Shanghai Chest hospital was conducted.There were6cases of single lung transplantation(2cases of re transplantation,4cases of lobe transplantation)and24cases of double lung transplantation.There were14cases of IPF,8cases of COPD,3cases of bronchiectasis,2cases of BOS,1case of bronchoalveolar carcinoma,1case of LAM and1case of immotile cilia syndrome.The cumulative survival rate and the major causes of death after1,3and5years after operation were analyzed.Results30day mortality was6.7%(2/30).Circulatory and cardiac failure were the main causes.90day mortality was13.3%(4/30).Stroke and massive airway bleeding were another two causes.1,3and5year survival rates were60%,50%,41%respectively.Pneumonia and anastomosis complications were the main causes of death in the first3years after transplantation.BOS was the main cause of death after the first3years of transplantation.ConclusionsLung transplantation was an effective treatment method in treating various end stage benign lung diseases.