肺移植治疗Ⅲ期矽肺32例临床分析  

Lung transplantation for phase Ⅲ silicosis：a series of 32 cases

作　　者：毛文君[1] 陈静瑜[1] 郑明峰[1] 陈若[1] 何毅军[1] 刘峰[1] 叶书高[1] 陆荣国[1] 

机构地区：[1]江苏省人体器官移植重点实验室南京医科大学附属无锡市人民医院胸外科肺移植中心,214023

出　　处：《中华外科杂志》2016年第12期902-907,共6页Chinese Journal of Surgery

基　　金：国家十一五科技支撑计划（2008BA160B05）

摘　　要：目的：探讨肺移植治疗Ⅲ期矽肺的有效性。方法回顾性分析2002年9月至2015年9月32例在南京医科大学附属无锡市人民医院胸外科接受肺移植治疗的Ⅲ期矽肺患者的临床资料。男性29例，女性3例，年龄24～63岁。32例患者均经当地职业病防治中心诊断为Ⅲ期矽肺，术前心功能（纽约心脏病协会分级）Ⅲ～Ⅳ级，Ⅰ型呼吸衰竭15例，Ⅱ型呼吸衰竭17例。14例接受序贯式双肺移植术，18例接受单肺移植术（右单肺13例，左单肺5例）；13例在体外膜式氧合辅助下完成移植手术。术后3个月、6个月、1年、2年定期监测肺功能。临床资料组间比较采用t检验、χ2检验和Fisher确切概率法，采用 Kaplan？Meier法绘制生存曲线， Log？rank 检验分析影响生存的因素。结果32例患者均顺利完成肺移植手术，1例术后8 d死于多器官功能衰竭，1例术后40 d死于脓毒血症，1例术后56 d死于心源性猝死。29例患者康复出院，随访过程中2例分别术后7个月死于重症感染，1例术后5个月死于肾功能衰竭，1例术后15个月死于心源性猝死，1例于术后122个月死于闭塞性细支气管炎。24例患者目前均存活良好，术后3个月、1年、3年、5年累积生存率分别为90？6％、80？8％、76？7％、76？7％，单、双肺移植术后长期生存率差异无统计学意义（ P＞0？05），术后肺功能较术前得到明显改善，且肺功能改善持久，患者生活质量得到极大提高。结论肺移植治疗Ⅲ期矽肺效果良好，术后患者可长期存活。Objective To evaluate the effect of lung transplantation for phase Ⅲ silicosis？Methods From September 2002 to September 2015, 32 patients with end？stage silicosis underwent lung transplantation at Department of Thoracic Surgery, Affiliated Wuxi People′s Hospital, Nanjing Medical University？ There were 29 male and 3 female patients aged from 24 to 63 years？ Thirty？two patients were diagnosed as phase Ⅲ silicosis by the local occupational disease prevention and control center？ Fifteen patients were type Ⅰrespiratory failure and 17 patients were typeⅡ？ There were 14 cases accepted bilateral sequential lung transplantation and 18 cases accepted single lung transplantation, including 13 cases with right single lung transplantation and 5 cases with left single lung transplantation？ Extracorporeal membrane oxygenation was used in 13 patients？ Pulmonary function monitoring was performed at 3 months,6 months, 1 year,and 2 years after lung transplantation？ Clinical characteristics were compared using t？test,χ2 test and Fisher exact test between groups, Kaplan？Meier survival curve and Log？rank test were used to find out the factors affecting survival？ Results All the patients received lung transplantation successfully？ One patient died of multiple organ failure, 1 died of sepsis, and 1 succumbed to sudden cardiac death？ Twenty？nine patients were discharged from hospital？ During follow？up, there were 5 deaths, two patients died of sepsis 7 months postoperatively, 1 died of renal failure 5 months post？transplant, 1 died of sudden cardiac death, and the remaining 1 patient died of bronchiolitis obliterans？ Twenty？four patients lived a good quality of life, with survival rates of 90？6% at 3 months, 80？8% at 1 year, 76？7% at 3 years, and 76？7% at 5 years？Significant difference was not observed between single and bilateral lung transplantation about long？term survival rate？ During follow？up pulmonary function post？transplant （ 3 months, 6 months, 1 year, a

关 键 词：肺移植 矽肺 治疗结果 

分 类 号：R655.3[医药卫生—外科学]