双肺移植治疗终末期良性肺病40例  

Clinical outcomes of lung transplantation for 40 patients with and stage benign lung disease

作　　者：施建新[1] 赵珩[1] 潘旭峰[1] 杨骏[1] 曹克坚[1] 付世杰[1] 姚峰[1] 赵洋[1] 高成新[1] 高文[1] 

机构地区：[1]上海交通大学附属胸科医院,上海200030

出　　处：《中华胸心血管外科杂志》2013年第5期286-289,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨双肺移植治疗慢性呼吸衰竭等终末期良性肺病的安全性和治疗效果。方法2003年1月至2012年5月，共完成40例序贯式双肺移植，其中特发性肺纤维化26例，弥漫性支气管扩张6例，慢阻肺5例，矽肺、双肺弥漫性淋巴管平滑肌瘤和原发性肺高压各1例。ECMO支持下完成手术36例，常规体外循环下完成2例，无体外支持下完成2例。结果术后30天内死亡4例（10％），主要原因是术中大量出血、移植肺早期失功能和由此而继发的多脏器衰竭。术后随访2～66个月，平均37个月，总1、3、5年生存率分别为65．0％（26／40）、55．0％（22／40）、42．5％（17／40）。影响术后长期生存的主要原因为感染和闭塞性细支气管炎综合征。随着经验的积累，近6年手术无术后30天内死亡，1、3年的生存率分别为83．3％（25／30）和70．0％（21／30）。结论双肺移植作为治疗终末期呼吸衰竭的手段安全、有效。可为患者提供更好的生活质量和更长的生存时间。Objective Lung transplantation is the only effective way to treat end-stage benign lung disease. Double lung transplantion is not widely adopted, because it is more complicated in anesthesia, surgical technique and perioperative care. We analysis 40 consecutive cases of sequential bilateral lung transplantation in our hospital and discuss its safety and therapeutic effect in treating chronic respiratory failure. Methods 40 double lung transplantations were conducted in Shanghai Chest Hospital from January 2003 to May 2012. There were 26 cases of idiopathic pulmonary fibrosis, 6 cases of diffuse bronchiectsis, 5 cases of COPD, 1 case of silicosis, 1 case of pulmonary lymphangioleiomyomatosis（LAM） and 1 case of primary pulmonary hypertension （PPH）. 36 cases were conducted with ECMO, 2 cases with cardiopuhnonary bypass（ CPB）, 2 cases without CPB. Results 30 day motality rate was 10% （4cases）. The leading cause were intraoperative massive bleeding, graft failure and the secondary multiple organ disfunction. Average follow-up time was 37 months （ 2 - 66 months）. 1 -, 3-, 5-year survival rale were 65.0% （26/40） ,55.0% （22/40） and 42.5% （17/40）. Infection and bronchiolitis obliterans syndrome（BOS） are the main reason influence long term survival. In the recent 6 years, 30 day mortality rate＇was 0. 1,3 year survival rate was 83.3% （25/30） and 70.0% （21/30）. Conclusion Double lung transplantion is technically highly demanded. However, with the increasing of our experience, it becomes a safe way to treat end stage lung disease. Comparing to single lung transplantation, double lung transplantation carrys out better quality of life and longer survival.

关 键 词：肺移植 手术后并发症 无病生存 

分 类 号：R563[医药卫生—呼吸系统] R65[医药卫生—内科学]