儿童肺移植12例经验分析

Experience analysis of 12 pediatric lung transplantation

目的总结12例儿童肺移植的临床经验。方法回顾性分析南京医科大学附属无锡市人民医院2007年12月—2020年8月实施的12例儿童肺移植的资料,重点对适应证、术后并发症及生存率进行分析。结果12例患儿行肺移植,其中男性5例,女性7例。患儿行肺移植时年龄为2~17岁(年龄中位数为13.5岁),小于12岁5例,占比41.7%;体重为15~55 kg(体重中位数为45 kg)。术前诊断为特发性肺动脉高压4例(33.3%),闭塞性细支气管炎3例(25%),间质性肺病3例(25%),先天性心脏病1例(8.3%),肺囊性纤维化1例(8.3%)。受者均接受ABO血型相同或相容供肺。免疫抑制方案采用环孢素或他克莫司+吗替麦考酚酯+泼尼松。术后并发症,包括感染10例,心功能不全3例,原发性移植物功能障碍2例,术后出血1例,气道狭窄1例。患者术后均康复出院,1例气道狭窄合并感染于术后6个月死亡。结论肺移植治疗儿童终末期肺病是安全、有效的,应注意选择合适的供、受者,加强术中操作和术后的管理,积极预防并发症,以提高受者生存率。

Objective To summarize the clinical experience of 12 children with lung transplantation.Methods We carried out a retrospective analysis on the data of 12 pediatric lung transplantation performed between December 2007 and August 2020,focusing on the indications,postoperative complications and survival rate.Results Twelve children underwent lung transplantation,including 5 males and 7 females.The age of patients were aged 2 to 17 years old at the time of lung transplantation(median age was 13.5 years old),and 5 cases were younger than 12 years old,accounting for 41.7%;their weight varies between 15 to 55 kg(median weight was 45 kg).According to the preoperative diagnosis,4(33.3%)had idiopathic pulmonary hypertension,3(25%)had bronchiolitis obliterans,3(25%)had interstitial lung disease,and 1(8.3%)had congenital heart disease and 1(8.3%)had pulmonary cystic fibrosis.The recipients all received lung grafts with identical or compatible ABO blood type.Cyclosporine or tacrolimus,mycophenolate mofetil and prednisone were applied as the immunosuppressive therapy.Postoperative complications included 10 cases of infection,3 cases of cardiac dysfunction,2 cases of primary graft dysfunction,1 case of postoperative bleeding,and 1 case of airway stenosis.All patients recovered and were discharged after the operation.One patient died 6 months after the operation because of airway stenosis complicated with infection.Conclusion Lung transplantation is a safe and effective way to treat end-stage lung disease in children.We should pay more attention to selecting appropriate donors and recipients,standardizing operations,strengthening postoperative management and actively preventing complications in order to improve the survival rate of recipients.