单肺移植治疗终末期肺气肿的围手术期影像学改变

Thoracic imaging of lung complications after single-lung transplantation for end-stage emphysema

目的 探讨肺移植治疗终末期肺病肺气肿围手术期的影像学改变。方法 1例肺气肿、肺功能重度减损的患者进行左肺移植 ,使用X线及CT观察手术前后影像学变化。结果 术后移植肺大片雪白致密影 ,呈完全不透亮的肺再植反应 ,第 4天曾一度出现急性对侧患肺过度膨胀 ,纵隔左移、压迫移植肺 ,术后 93h顺利脱机 ,第 5天出现对侧肺感染 ,术后第 9天胸片示移植肺片状模糊影 ,呈磨玻璃样改变 ,经活检为急性排异 ,经大剂量甲基泼尼松龙冲击治疗后症状消退 ,术后 4 0d胸部CT示左肺扩张良好 ,左肺血液灌注良好 ,术后肺功能明显改善 ,术后 4 7d出院 ,现已恢复工作。结论 单肺移植术后影像学改变对术后并发症的诊断与处理有非常重要的指导价值。

Objective To determine the radiologic features of lung complications after single-lung transplantation for end-stage emphysema.Methods A 56-year-old male with end-stage emphysema received a left-lung transplantation in our hospital on 28 Sep.2002.The surgical technic used was similar to that mentioned in the literature.The chest radiography and CT scan were conducted to detect the thoracic imaging changes during perioperation period.Results Reperfusion edema,also known as the reimplantation response,occurred in the lung allograft immediately after transplantation and was resolved in the first few days.There was a hyperinflation and pneumonia of the native lung at the first few days.The patient weaned from ventilator on the 93 hours after operation.Immunosuppression included cyclosporine.mycophenolate mofetil and corticosteroid.The acute rejection occurred on the 9 th day after operation and was cured by bolus methylprednisolone given intravenously.His lung function was improved significantly and he was discharged from hospital 47 days after operation.After discharge from the hospital,the patients could return to an almost normal life.Conclusion Thoracic imaging has proved useful in the diagnosis of complications of single-lung transplantation for end-stage emphysema.