单肺移植与双肺移植治疗终末期肺纤维化的效果比较  

Single-lung transplantation versus double-lung transplantation in patients with end-stage pulmonary fibrosis

作　　者：田静 董妍 张佳悦 许红阳 Tian Jing;Dong Yan;Zhang Jiayue;Xu Hongyang(Department of Critical Care Medicine,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214000,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡人民医院重症医学科,江苏无锡214000

出　　处：《实用器官移植电子杂志》2024年第1期3-7,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：无锡市卫生健康委科研项目青年项目(Q202054);无锡市“太湖人才计划”高端医学专家团队(2021THRC-TD-ZZYXK-2021)。

摘　　要：目的比较单肺移植(single lung transplantation,SLT)与双肺移植(bilateral lung transplantation,BLT)治疗终末期肺纤维化的临床效果,为临床治疗的选择提供一定参考。方法回顾性分析2020年2月至2020年12月期间在南京医科大学附属无锡人民医院进行肺移植的肺纤维化患者,共纳入72例患者,手术类型分为两组,分别为单肺移植组(24例)、双肺移植组(48例)。对两组患者的术前一般资料、术中情况、术后肺功能及并发症进行统计学分析。结果单肺移植组年龄大于双肺移植组[65(57,69.75)岁比55(48,61.75)岁,P<0.05],符合本中心在高龄患者中优选择单肺移植的实践模式,在其余术前临床资料上具有可比性(P>0.05)。双肺移植组术后用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积占预计值百分比(FEV1%pred)均优于单肺移植组(P<0.05),但在术中,单肺移植组供体冷缺血时间、手术时间较双肺移植组短,术中出血量较双肺移植组少(P<0.05),并且在术后开胸止血、支气管狭窄以及原发性移植物功能障碍(primary graft dysfunction,PGD)的发生率方面无显著差别(P>0.05)。结论双肺移植治疗终末期肺纤维化具有一定优势,有效改善患者术后肺功能,但对患者进行筛选后,单肺移植仍应纳入选择范围。Objective The clinical effects of single lung transplantation(SLT)and bilateral lung transplantation(BLT)in the treatment of end-stage pulmonary fibrosis were compared to provide a reference for the choice of clinical treatment.Methods Retrospective analysis of patients with pulmonary fibrosis who underwent lung transplantation at Wuxi People's Hospital affiliated to Nanjing Medical University between February 2020 and December 2020 was performed,a total of 72 patients were included,and were divided into two groups based on the type of surgery,including single-lung transplantation group(24 cases)and bilateral-lung transplant transplantation group(48 cases).Preoperative characteristics,intraoperative conditions,functional improvement and postoperative complications between the two groups were analyzed retrospectively.Results The age in SLT group was significantly older than the BLT group〔65(57,69.75)years vs 55(48,61.75)years,P<0.05〕,which was in consistent with the fact that single lung transplantation was mostly performed in the elderly patients in this center.The two groups were comparable in other preoperative clinical data(P>0.05).The predicted value of FVC%and FEV1%in the BLT group were better than those in the SLT group(P<0.05).However the cold ischemia time and total operation time were shorter in the SLT group than in the BLT group,and the intraoperative blood loss was less in SLT group than that in the BLT group(P<0.05).There were no significant differences between the two groups in the incidence of bronchial stenosis,bronchial stenosis,bronchial stenosis and primary graft dysfunction(P>0.05).Conclusion BLT has advantages in treating patients with end-stage pulmonary fibrosis and can effectively improve postoperative lung function,but SLT should still be considered in some selected patients.

关 键 词：肺移植 肺纤维化 肺功能 并发症 

分 类 号：R655.3[医药卫生—外科学]