肺移植8例临床经验总结
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摘要
目的探讨肺移植治疗终末期肺良性疾病的效果,并对我院肺移植的经验进行总结。方法回顾分析2017年6月至2018年5月安徽省立医院完成的8例肺移植病例的临床资料,受者年龄为20-63岁,中位年龄36岁;男性6例,女性2例;单肺3例,双肺5例。原发病为慢性阻塞性肺病2例,肺纤维化1例,肺淋巴管肌瘤病1例,α-糜蛋白酶缺乏症1例,矽肺1例,支气管扩张症1例,呼吸道化学性烧伤1例。对所有受者的并发症发生情况、死亡情况及随访情况进行分析。结果没有围手术期死亡病例。术后早期胸腔出血二次手术止血1例。支气管胸膜瘘2例,经保守治疗2月后好转。1例术后2月出现急性肾衰。5例出现移植后气道狭窄。3例术后出现肺部感染,其中2例合并支气管胸膜瘘。1例术后10月因心衰死亡。结论肺移植是治疗终末期肺良性疾病的有效方法,恰当的病例选择、良好的供肺选择及保护、有效的术后管理是肺移植成功的关键。
Objective To explore the clinical outcomes of lung transplantation for end-stage lung diseases,and to summarize the experience. Methods The clinical data of 8 patients who underwent lung transplantation from 2017 Jun to 2018 May in Anhui Provincial Hospital were retrospectively analyzed. Their ages ranged from 20 to 63 years old,and the median age was 36. There were 6 males and 2 females. There were 3 cases of unilateral lung and 5 cases of bilateral lung who received transplantation. The primary diseases included 2 cases of chronic obstructive pulmonary disease( COPD),1 case of pulmonary fibrosis,1 case of pulmonary lymphangiomyomatosis,1 case of α-chymotrypsin deficiency,1 case of silicosis,1 case of bronchiectasis and 1 case of air way chemical burn. Their clinical data of complications,death and follow-up were analyzed retrospectively. Results There was no operative mortality occurred. There was one re-operation to stop bleeding for early postoperative pleural hemorrhage. Two cases of bronchial pleural fistula were cured after 2 months of conservative treatment. 1 case occurred acute renal failure 2 months after transplantation. 5 cases of airway stenosis occurred after transplantation. Pulmonary infection occurred in 3 cases,2 of which were complicated with bronchial pleural fistula. 1 case died of heart failure 10 months after surgery. Conclusion Lung transplantation is an effective method to treat end-stage pulmonary benign diseases. Proper case selection,good donor lung selection and protection,and effective postoperative management are the keys of success.
Objective To explore the clinical outcomes of lung transplantation for end-stage lung diseases,and to summarize the experience. Methods The clinical data of 8 patients who underwent lung transplantation from 2017 Jun to 2018 May in Anhui Provincial Hospital were retrospectively analyzed. Their ages ranged from 20 to 63 years old,and the median age was 36. There were 6 males and 2 females. There were 3 cases of unilateral lung and 5 cases of bilateral lung who received transplantation. The primary diseases included 2 cases of chronic obstructive pulmonary disease( COPD),1 case of pulmonary fibrosis,1 case of pulmonary lymphangiomyomatosis,1 case of α-chymotrypsin deficiency,1 case of silicosis,1 case of bronchiectasis and 1 case of air way chemical burn. Their clinical data of complications,death and follow-up were analyzed retrospectively. Results There was no operative mortality occurred. There was one re-operation to stop bleeding for early postoperative pleural hemorrhage. Two cases of bronchial pleural fistula were cured after 2 months of conservative treatment. 1 case occurred acute renal failure 2 months after transplantation. 5 cases of airway stenosis occurred after transplantation. Pulmonary infection occurred in 3 cases,2 of which were complicated with bronchial pleural fistula. 1 case died of heart failure 10 months after surgery. Conclusion Lung transplantation is an effective method to treat end-stage pulmonary benign diseases. Proper case selection,good donor lung selection and protection,and effective postoperative management are the keys of success.
引文
[1] YUSEN R D,CHRISTIE J D,EDWARDS L B,et al. The registry of the international society for heart and lung transplantation:Thirtieth adult lung and heart-lung transplant report-2013; focus theme:Age[J]. J Heart Lung Transplant,2013,32(10):965-978.
[2]毛文君,陈静瑜,郑明峰,等.肺移植100例临床分析[J].中华器官移植杂志,2013,34(1):28-32.
[3]潘旭峰,付世杰,杨骏,等.上海市胸科医院肺移植10年经验总结[J/OL].中华胸部外科电子杂志,2017,4(4):224-227[2018-08-01]. http://med. wanfangdata. com. cn/Paper/Detail? id=Periodical Paper_zhxbwkdzzz201704006&dbid=WF_QK. DOI:10. 3877/cma. j. issn. 2095-8773. 2017. 04. 06.
[4] CHRISTIE J D,EDWARDS L B,KUCHERYAVAYA A Y,et al.The registry of the International Society for Heart and Lung Transplantation:Twenty-seventh official adult lung and heart-lung transplant report--2010[J]. J Heart Lung Transplant,2010,29(10):1104-1118.
[5] PORTEOUS M K,DIAMOND J M,CHRISTIE J D. Primary graft dysfunction:Lessons learned about the first 72h after lung transplantation[J]. Curr Opin Organ Transplant,2015,20(5):506-514.
[6] ANDREASSON A S I,KARAMANOU D M,GILLESPIE C S,et al. Profiling inflammation and tissue injury markers in perfusate and bronchoalveolar lavage fluid during human ex vivo lung perfusion[J]. Eur J Cardiothorac Surg,2017,51(3):577-586.
[7] WALLINDER A,RIISE G C,RICKSTEN S E,et al. Transplantation after ex vivo lung perfusion:A midterm follow-up[J]. J Heart Lung Transplant,2016,35(11):1303-1310.
[8] ZERIOUH M,SABASHNIKOV A,MOHITE P N,et al. Utilization of the organ care system for bilateral lung transplantation:Preliminary results of a comparative study[J]. Interact Cardiovasc Thorac Surg,2016,23(3):351-357.
[9] CHRISTIE J D,EDWARDS L B,KUCHERYAVAYA A Y,et al.The registry of the International Society for Heart and Lung Transplantation:29th adult lung and heart-lung transplant report–2012[J]. J Heart Lung Transplant,2012,31(10):1073–1086.
[10]陈静瑜.肺移植供体肺的维护及获取[J].武汉大学学报(医学版),2016,37(4):540-542.
[11] CHO E N,HAAM S J,KIM S Y,et al. Anastomotic airway complications after lung transplantation[J]. Yonsei Med J,2015,56(5):1372-1378.
[12] ALRAIYES A H,INATY H,MACHUZAK M S. Vanishing bronchus after lung transplantation:The role of sequential airway dilatations[J]. Ochsner J,2017,17(1):71-75.
[2]毛文君,陈静瑜,郑明峰,等.肺移植100例临床分析[J].中华器官移植杂志,2013,34(1):28-32.
[3]潘旭峰,付世杰,杨骏,等.上海市胸科医院肺移植10年经验总结[J/OL].中华胸部外科电子杂志,2017,4(4):224-227[2018-08-01]. http://med. wanfangdata. com. cn/Paper/Detail? id=Periodical Paper_zhxbwkdzzz201704006&dbid=WF_QK. DOI:10. 3877/cma. j. issn. 2095-8773. 2017. 04. 06.
[4] CHRISTIE J D,EDWARDS L B,KUCHERYAVAYA A Y,et al.The registry of the International Society for Heart and Lung Transplantation:Twenty-seventh official adult lung and heart-lung transplant report--2010[J]. J Heart Lung Transplant,2010,29(10):1104-1118.
[5] PORTEOUS M K,DIAMOND J M,CHRISTIE J D. Primary graft dysfunction:Lessons learned about the first 72h after lung transplantation[J]. Curr Opin Organ Transplant,2015,20(5):506-514.
[6] ANDREASSON A S I,KARAMANOU D M,GILLESPIE C S,et al. Profiling inflammation and tissue injury markers in perfusate and bronchoalveolar lavage fluid during human ex vivo lung perfusion[J]. Eur J Cardiothorac Surg,2017,51(3):577-586.
[7] WALLINDER A,RIISE G C,RICKSTEN S E,et al. Transplantation after ex vivo lung perfusion:A midterm follow-up[J]. J Heart Lung Transplant,2016,35(11):1303-1310.
[8] ZERIOUH M,SABASHNIKOV A,MOHITE P N,et al. Utilization of the organ care system for bilateral lung transplantation:Preliminary results of a comparative study[J]. Interact Cardiovasc Thorac Surg,2016,23(3):351-357.
[9] CHRISTIE J D,EDWARDS L B,KUCHERYAVAYA A Y,et al.The registry of the International Society for Heart and Lung Transplantation:29th adult lung and heart-lung transplant report–2012[J]. J Heart Lung Transplant,2012,31(10):1073–1086.
[10]陈静瑜.肺移植供体肺的维护及获取[J].武汉大学学报(医学版),2016,37(4):540-542.
[11] CHO E N,HAAM S J,KIM S Y,et al. Anastomotic airway complications after lung transplantation[J]. Yonsei Med J,2015,56(5):1372-1378.
[12] ALRAIYES A H,INATY H,MACHUZAK M S. Vanishing bronchus after lung transplantation:The role of sequential airway dilatations[J]. Ochsner J,2017,17(1):71-75.