单肺移植治疗终末期肺病肺气肿

Single-lung transplantation for end-stage emphysema

目的 探讨单肺移植治疗终末期肺病肺气肿的术式、手术适应证及围手术期的处理方法。 方法 2 0 0 2年 9月 2 8日为 1例肺气肿、肺功能重度降低的患者进行左肺移植。 结果 患者术后 93h顺利脱离呼吸机 ;术后第 9天发生 1次急性排异反应 ,经大剂量甲基强的松龙冲击治疗后症状消退 ;术后第 2 0天胸部CT显示左肺扩张、血液灌注良好。患者术后肺功能明显改善 ,第 4 7天出院。 结论 肺移植是治疗终末期肺病肺气肿的有效方法。

ObjectiveTo evaluate operative technique,patient selection and perioperative management of single-lung transplantation for a patients with end-stage emphysema.MethodsA 56-year-old patient with end-stage emphysema underwent left-lung transplantation on September 28, 2002.The surgical technique used was similar to that mentioned in the literature.The donor lung was perfused by LPD solution with a cold ischemic time of 260 minutes.Cardiopulmonary bypass was not performed.Results The patient weaned from a ventilator at the 93th hour after operation.Immunosuppressants included cyclosporine,mycophenolate mofetil and corticosteroid. Acute rejection occurred on the ninth day after operation and was cured by bolus methylprednisolone given intravenously. Lung function was improved significantly and the patient was discharged from the hospital on the 47th day after operation.Conclusion Single-lung transplantation for patients with end-stage emphysema is effective for long-term improvement of pulmonary function.