双肺移植治疗细支气管肺泡癌1例临床分析  

Clinical analysis of bilateral lung transplantation for bronchioloalveolar carcinoma in one patient

作　　者：李丰科[1] 王跃斌[1] 丁志丹[1] 赵凯 冯敏[2] 刘刚[2] 李高飞 金峰[3] 赵高峰[1] LI Fengke;WANG Yuebin;DING Zhidan;ZHAO Kai;FENG Min;LIU Gang;LI Gaofei;JIN Feng;ZHAO Gaofeng(Department of Thoracic Surgery/Lung Transplantation Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Surgical ICU,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Anesthesiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院胸外科/肺移植外科,河南郑州450052 [2]郑州大学第一附属医院外科ICU,河南郑州450052 [3]郑州大学第一附属医院麻醉科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2023年第7期649-653,共5页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨1例细支气管肺泡癌患者行双肺移植治疗的临床效果。方法 2023年5月14日郑州大学第一附属医院收治细支气管肺泡癌患者1例,男,66岁。临床表现为咳嗽、胸闷,院外误诊为肺炎,抗炎治疗2年后行支气管镜肺组织活检病理检查诊断为细支气管肺泡癌。入院后行全身PET-CT、超声检查显示肿瘤病变局限于肺部,无胸膜转移、无远处转移;胸部CT提示双肺弥漫性多发粟粒状、小结节状及点片状融合病变。行双肺移植术治疗,体外膜肺氧合下先切除左侧病肺,淋巴结清扫后行左肺移植,再切除右侧病肺,淋巴结清扫后行右肺移植。记录患者术中及术后临床资料。结果 手术时间445 min,术中出血量800 mL,手术过程顺利,未发生移植物失功,术后即刻X线胸片显示双肺膨胀可、与胸腔大小匹配。术后13 h撤除体外膜肺氧合,术后18 h撤离呼吸机,撤机后体积分数50%氧浓度下pa(O_(2))由术前38.2 mmHg升高至225.0 mmHg。术后组织病理检查结果提示双肺浸润性腺癌,中分化,右肺呈多发小灶性生长,左肺呈弥漫性多结节性生长,支气管断端及肺门未见特殊,双侧淋巴结未见癌转移。患者术后第3天下床活动,使用高流量与无创呼吸机交替通气,逐渐改为鼻导管吸氧至脱离氧气,血氧饱和度97%,心率82次/min,血压108/72 mmHg,呼吸频率17次/min;实验室检查示白细胞计数8.52×10^(9)/L,钾离子3.64 mmol/L,钠离子136 mmol/L,氯离子102.9 mmol/L,血肌酐73μmoI/L,尿素11.43 mmol/L,均基本正常。术后第13天康复出院,随访至2023年5月30日,患者基本活动不受限,目前有序锻炼康复中。结论 细支气管肺泡癌患者临床和影像学表现与肺炎相近;对于病变局限于肺部,无胸膜转移、无远处转移的细支气管肺泡癌患者,可行肺移植术治疗。Objective To investigate the clinical effect of bilateral lung transplantation in one patient with bronchioloalveolar carcinoma.Methods A 66-year-old male patient with bronchoalveolar carcinoma was admitted to the First Affiliated Hospital of Zhengzhou University on May 14,2023.Before admission,the patient was misdiagnosed with pneumonia due to cough and chest tightness,and was diagnosed with bronchioloalveolar carcinoma by bronchoscopy lung biopsy after 2-year anti-inflammatory treatment.Whole-body PET-CT and ultrasound examination after admission showed that the tumor lesions were limited to the lungs,without pleural metastasis or distant metastasis.Chest CT showed diffuse multiple miliary,small nodular,and point-like fusion lesions in both lungs.Bilateral lung transplantation included the resection of left lung under extracorporeal membrane oxygenation(ECMO),followed by lymph node dissection and left lung transplantation,and the resection of right lung,followed by lymph node dissection and right lung transplantation.The intraoperative and postoperative clinical data were recorded.Results The operation was successfully completed in 445 min,with the intraoperative blood loss of 800 mL and no graft loss.The chest X-ray immediately after operation showed well expanded lungs,which matched the size of chest cavity.ECMO was weaned 13hafter operation.After the ventilator was withdrawn 18hafter operation,pa(O_(2))increased to 225mmHg from 38.2mmHg preoperatively at 50% oxygen concentration.The postoperative histopathological results showed moderately differentiated infiltrating adenocarcinoma in both lungs,with multiple small focal growth in the right lung and diffuse multinodular growth in the left lung.No abnormalities in bronchial stump and pulmonary hilum,or no metastasis in bilateral lymph nodes were found.By day 3after operation,the patient began to take out-of-bed activities,received high-flow ventilation and non-invasive ventilation alternatively,followed by nasal catheter oxygen inhalation.The blood oxygen sat

关 键 词：细支气管肺泡癌 双肺移植 肺炎 

分 类 号：R734.2[医药卫生—肿瘤]