成人肺叶移植术后早期死亡原因分析及诊疗经验

Causes analysis and treatment experience of early postoperative death after lobar lung transplantation in adults

目的分析7例成人肺叶移植术后3个月内死亡原因,总结诊疗经验,提高早期存活率。方法回顾性分析2016年1月至2022年12月期间广州医科大学附属第一医院行成人肺叶移植并术后3个月内死亡的7例受者的临床资料。总结分析其年龄、性别、术前状态、裁切肺叶原因、手术方式、术后管理方案及主要死亡原因。结果7例死亡受者占同期所有肺叶移植受者的15.6%,7例中男性5例,女性2例,年龄63岁(49~72岁)。5例受者术前状态稳定,2例术前状态危重并气管插管。4例行一侧肺叶移植并对侧肺移植,2例行双侧肺叶移植,1例行单侧肺叶移植。5例因供肺感染炎症裁切肺叶,2例因大小匹配问题裁切肺叶。3例留有残端,4例无残端。3例受者因肺部感染死亡,2例因供肺残端瘘死亡,1例因肾衰竭死亡,1例因心功能不全死亡。结论成人肺叶移植术后3个月死亡率较高,应综合考虑感染、支气管残端、器官功能不全等危险因素,减少术后早期死亡。

Objective To explore the causes of postoperative mortality within 3 months after lobar lung transplantation and summarize the institutional experiences of diagnosis and treatment so as to improve its early survival rate.Methods From January 2016 to December 2022,7 adults underwent lobar lung transplantation and died within 3 months post-lung transplantation at First Affiliated Hospital of Guangzhou Medical University.Age,gender,preoperative status,reasons of lobar lung transplantation,surgical approaches,postoperative managements and major causes of death were summarized.Results The 3-month postoperative mortality rate was 15.6%.Seven of them died within 3 months.There were 5 males and 2 females with a mean age of 63(49-72)year.Preoperatively 5 recipients stayed in a stable condition and 2 cases were critical with mechanical ventilation.Single lobar LT plus contralateral lung transplantation(4 cases),bilateral lobar LT(2 cases)and unilateral lobar lung transplantation(1 case)were performed.Lobar resection was due to pneumonia of donor lung(5 cases)and size mismatch(2 cases).Cause of mortality was pneumonia(3 cases),bronchial stump fistula(2 cases),kidney failure(1 case)and cardiac failure(1 case).Conclusions Early 3 months mortality remains high after adult lobar lung transplantation.All risk factors should be comprehensively considered for lowering early mortality.