CAJ | 학술논문

目的探讨肺移植治疗矽肺的手术适应证、围术期的处理及疗效.方法对经当地职业病防治中心诊断为矽肺的5例终末期矽肺患者进行了肺移植治疗.移植前5例患者的X线胸片、CT提示不同程度的肺间质纤维化、肺气肿伴肺大泡、伴大小不等的肺结节团块影,平均肺动脉压均＞30mm Hg,心功能Ⅲ-Ⅳ级;2例术前有胸部手术史,呼吸机依赖1例.5例矽肺患者中,1例在体外膜肺氧合(ECMO)辅助下行续贯式双肺移植,4例接受单肺移植,其中3例在ECMO辅助下完成.结果病例5于术后8 d因多器官功能衰竭死亡,其余4例均康复出院.随访中病例3术后7月死于重症感染,病例1、病例2、病例4现已分别存活5、3、2年.患者术后肺动脉压下降,肺功能得到明显改善,生活质量良好.有轻度的慢性排异,出现闭塞性细支气管炎(BOS)的表现.结论肺移植对治疗终末期矽肺有效,单、双肺移植治疗矽肺均有较好的应用前景,患者远期的生存还需进一步观察.
목적 탐토폐이식치료석폐적수술괄응증、위술기적처리급료효.방법 대경당지직업병방치중심진단위석폐적5례종말기석폐환자진행료폐이식치료.이식전5례환자적X선흉편、CT제시불동정도적폐간질섬유화、폐기종반폐대포、반대소불등적폐결절단괴영,평균폐동맥압균＞30mm Hg,심공능Ⅲ-Ⅳ급;2례술전유흉부수술사,호흡궤의뢰1례.5례석폐환자중,1례재체외막폐양합(ECMO)보조하행속관식쌍폐이식,4례접수단폐이식,기중3례재ECMO보조하완성.결과 병례5우술후8 d인다기관공능쇠갈사망,기여4례균강복출원.수방중병례3술후7월사우중증감염,병례1、병례2、병례4현이분별존활5、3、2년.환자술후폐동맥압하강,폐공능득도명현개선,생활질량량호.유경도적만성배이,출현폐새성세지기관염(BOS)적표현.결론 폐이식대치료종말기석폐유효,단、쌍폐이식치료석폐균유교호적응용전경,환자원기적생존환수진일보관찰.
Objective To investigate the selection of recipients, operative technique, and perioperative management of lung transplantation for silicosis. Methods Lung transplantations(LTx) were performed for five end-stage silicosis in our hospital who were diagnosed in accordance with recommendations of the local Prophylactico-Therapetic Institution for Occupational Diseases.The chest roentgenogram and high resolution CT showed somewhat pulmonary interstitial fibrosis, pulmonary emphysema and massive opacities. The mean pulmonary artery pressure (mPAP) was＞30mmHg,NYHA Ⅲ or Ⅳ. Two patients received thoracic surgery prior to LTx,one patient was ventilator-dependent. One patient received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support. Four patients received single lung transplantation (SLT),3 under ECMO support. Results Patient five died of multiple organ failure on postoperative day 8,the remaining four patients were discharged from hospital.During follow up,patient three died of severe infection 7 month postoperatively,the remaining three patients were alive for 5 years, 3 years and 2 years respectively,and lived good quality of life, especially with lower mPAP and improved lung function.Although our patients suffered low-grade chronic rejection with the manifestation of bronchiolitis obliterative syndrome (BOS). Conclusion Lung transplantation is a viable option for patients with end-stage silicosis,providing acceptable quality of life and survival.Both SLT and BSLT are satisfactory approach for end-stage silicosis.and long-term survival requires further investigations.