双肺移植同期Nuss手术治疗造血干细胞移植术后闭塞性细支气管炎综合征合并胸廓畸形长期生存1例  

Long-term survival of bilateral lung transplantation combined with Nuss operation on treatment of bronchiolitis obliterans syndrome complicated with thoracic deformity after hematopoietic stem cell transplantation: report of one case

作　　者：丁浩[1] 毛文君[1] 刘峰[1] 范立[1] 陈静瑜[1] Ding Hao;Mao Wenjun;Liu Feng;Fan Li;Chen Jingyu(Department of Thoracic Surgery and Lung Transplantation Center,Wuxi People＇s Hospital Affliated to Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡市人民医院胸外科暨肺移植中心,江苏无锡214023

出　　处：《器官移植》2018年第4期268-271,277,共5页Organ Transplantation

基　　金：江苏省科教强卫工程青年医学重点人才项目(QNRC2016193);南京医科大学科技发展基金面上项目(2015NJMU146)

摘　　要：目的探讨双肺移植同期Nuss手术治疗造血干细胞移植术后闭塞性细支气管炎综合征(BOS)合并漏斗胸的疗效。方法 2015年3月24日,1例造血干细胞移植术后BOS合并漏斗胸患者在南京医科大学附属无锡市人民医院胸外科暨肺移植中心接受体外膜肺氧合(ECMO)辅助下双肺移植术,同期行Nuss手术矫治漏斗胸,手术顺利,术后予抗炎、抗真菌预防治疗,予他克莫司+吗替麦考酚酯+肾上腺皮质激素三联免疫抑制方案治疗。结果患者术后恢复顺利,于术后25 d出院,术后2年拆除胸部Nuss钢板,胸廓畸形得到纠正,术后接受长期随访,截止至投稿日,患者存活3年余,肺功能恢复良好,生活质量满意。结论双肺移植同期Nuss手术是治疗终末期BOS合并胸廓畸形的有效办法。Objective To evaluate the clinical efficacy of bilateral lung transplantation combined with Nuss operation on the treatment of bronchiolitis obliterans syndrome（BOS） complicated with pectus excavatum after hematopoietic stem cell transplantation. Methods On March 24, 2015, one patient presenting with BOS complicated with pectus excavatum after hematopoietic stem cell transplantation underwent extracorporeal membrane oxygenation（ECMO）-assisted bilateral lung transplantation in the Department of Thoracic Surgery and Lung Transplantation Center of Wuxi People＇s Hospital affiliated to Nanjing Medical University. Simutaneously, Nuss operation was successfully performed to treat pectus excavatum. After anti-inflammation and anti-fungal treatment, a triple immunosuppressive regimen consisting of tacrolimus ＋ mycophenolate mofetil ＋ adrenocortical hormone was implemented. Results The patient was properly recovered and discharged on 25 d after operation. The Nuss steel plate was removed from the chest at postoperative 2 years. The thoracic deformity was corrected. The patient received long-term postoperative follow-up. Until submission date, the patient survived for more than 3 years. The lung function was well restored and the quality of life was satisfactory. Conclusions Bilateral lung transplantation combined with Nuss operation is an effective approach in the treatment of end-stage BOS complicated thoracic deformity.

关 键 词：肺移植 造血干细胞移植 闭塞性细支气管炎 矫治术 胸廓畸形 漏斗胸 体外膜肺氧合 

分 类 号：R617[医药卫生—外科学] R682[医药卫生—临床医学]