肺癌肺移植一例临床分析并文献复习  

Lung transplantation for lung cancer: a clinical report and literature review

作　　者：周振宇[1] 叶芃[1] 泮辉[1] 汪路明[1] 李洲斌[1] 赵琼[2] 吕望[1] 胡坚[1] 

机构地区：[1]浙江大学医学院附属第一医院胸外科,杭州310003 [2]浙江大学医学院附属第一医院肺移植及胸部肿瘤科,杭州310003

出　　处：《中华移植杂志（电子版）》2015年第2期23-26,共4页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金面上项目(81373161);浙江省医药卫生平台重点资助计划(2012ZDA017)

摘　　要：目的结合1例肺癌肺移植受者临床资料及国内外研究现状,探讨肺癌肺移植临床应用价值。方法回顾性分析浙江大学医学院附属第一医院胸外科2013年12月26日完成的1例肺癌肺移植受者临床资料。男性,66岁,原发病为双肺纤维化。在全身麻醉下行体外膜肺氧合辅助右侧单肺移植术。结合文献,对肺癌肺移植的适应证、术前评估、术式选择、术后治疗方案及预后等方面展开讨论,总结肺癌肺移植的临床应用价值。结果手术过程顺利,术中切除右侧病肺,其冰冻切片病理学检查示多发病灶腺癌,术后病理检查示多灶性肺泡上皮异型增生癌变。术后采用吗替麦考酚酯+类固醇激素免疫抑制方案,予呼吸机辅助通气,先后并发胸腔包裹性积血积液、气道内出血伴肺部严重感染,于术后7 d自动出院。结论肺移植在治疗非转移性肺部恶性肿瘤方面具有潜在的应用价值,需要严格选择适应证、明确病理分期并完善治疗方案,其远期预后有待进一步研究。Objective To investigate the research status and clinical application of lung transplantation for lung cancer. Methods The clinical data of one patient of lung transplantation for lung cancer was analyzed. A 66-year-old male, diagnosed as idiopathic pulmonary fibrosis preoperatively,was undergone right lung transplantation with assistance of extracorporeal membrane oxygenation. The indications,preoperative evaluation,surgical options,postoperative treatment and prognosis were analyzed. The clinical value of lung transplantation for lung cancer was discussed.Results The Intraoperative pathology of the resected lung frozen section showed multiple lesions adenocarcinoma. Postoperative treatment included mechanical ventilation and immunosuppressive regimen of mycophenolate mofetil and steroids. The patient was discharged seven days postoperatively as a result of multiple complications as encapsulated effusion, airway hemorrhage and severe lung infection. Conclusion Lung transplantation is valuable in the treatment of non-metastatic lung cancer,which requiring strict selecting of indications,clear staging and improved options. The long-term prognosis of lung transplantation for lung cancer needs further study.

关 键 词：肺移植 肺癌 腺癌 适应证 预后 

分 类 号：R734.2[医药卫生—肿瘤]