中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2013年
5期
286-289
,共4页
施建新%赵珩%潘旭峰%杨骏%曹克坚%付世杰%姚峰%赵洋%高成新
施建新%趙珩%潘旭峰%楊駿%曹剋堅%付世傑%姚峰%趙洋%高成新
시건신%조형%반욱봉%양준%조극견%부세걸%요봉%조양%고성신
肺移植%手术后并发症%无病生存
肺移植%手術後併髮癥%無病生存
폐이식%수술후병발증%무병생존
Lung transplantation%Postoperative complications%Disease-free survival
目的 探讨双肺移植治疗慢性呼吸衰竭等终末期良性肺病的安全性和治疗效果.方法 2003年1月至2012年5月,共完成40例序贯式双肺移植,其中特发性肺纤维化26例,弥漫性支气管扩张6例,慢阻肺5例,矽肺、双肺弥漫性淋巴管平滑肌瘤和原发性肺高压各1例.ECMO支持下完成手术36例,常规体外循环下完成2例,无体外支持下完成2例.结果 术后30天内死亡4例(10％),主要原因是术中大量出血、移植肺早期失功能和由此而继发的多脏器衰竭.术后随访2 ～ 66个月,平均37个月,总l、3、5年生存率分别为65.0％ (26/40)、55.0％(22/40)、42.5％(17/40).影响术后长期生存的主要原因为感染和闭塞性细支气管炎综合征.随着经验的积累,近6年手术无术后30天内死亡,1、3年的生存率分别为83.3％(25/30)和70.0％(21/30).结论 双肺移植作为治疗终末期呼吸衰竭的手段安全、有效.可为患者提供更好的生活质量和更长的生存时间.
目的 探討雙肺移植治療慢性呼吸衰竭等終末期良性肺病的安全性和治療效果.方法 2003年1月至2012年5月,共完成40例序貫式雙肺移植,其中特髮性肺纖維化26例,瀰漫性支氣管擴張6例,慢阻肺5例,矽肺、雙肺瀰漫性淋巴管平滑肌瘤和原髮性肺高壓各1例.ECMO支持下完成手術36例,常規體外循環下完成2例,無體外支持下完成2例.結果 術後30天內死亡4例(10％),主要原因是術中大量齣血、移植肺早期失功能和由此而繼髮的多髒器衰竭.術後隨訪2 ～ 66箇月,平均37箇月,總l、3、5年生存率分彆為65.0％ (26/40)、55.0％(22/40)、42.5％(17/40).影響術後長期生存的主要原因為感染和閉塞性細支氣管炎綜閤徵.隨著經驗的積纍,近6年手術無術後30天內死亡,1、3年的生存率分彆為83.3％(25/30)和70.0％(21/30).結論 雙肺移植作為治療終末期呼吸衰竭的手段安全、有效.可為患者提供更好的生活質量和更長的生存時間.
목적 탐토쌍폐이식치료만성호흡쇠갈등종말기량성폐병적안전성화치료효과.방법 2003년1월지2012년5월,공완성40례서관식쌍폐이식,기중특발성폐섬유화26례,미만성지기관확장6례,만조폐5례,석폐、쌍폐미만성림파관평활기류화원발성폐고압각1례.ECMO지지하완성수술36례,상규체외순배하완성2례,무체외지지하완성2례.결과 술후30천내사망4례(10％),주요원인시술중대량출혈、이식폐조기실공능화유차이계발적다장기쇠갈.술후수방2 ～ 66개월,평균37개월,총l、3、5년생존솔분별위65.0％ (26/40)、55.0％(22/40)、42.5％(17/40).영향술후장기생존적주요원인위감염화폐새성세지기관염종합정.수착경험적적루,근6년수술무술후30천내사망,1、3년적생존솔분별위83.3％(25/30)화70.0％(21/30).결론 쌍폐이식작위치료종말기호흡쇠갈적수단안전、유효.가위환자제공경호적생활질량화경장적생존시간.
Objective Lung transplantation is the only effective way to treat end-stage benign lung disease.Double lung transplantion is not widely adopted,because it is more complicated in anesthesia,surgical technique and perioperative care.We analysis 40 consecutive cases of sequential bilateral lung transplantation in our hospital and discuss its safety and therapeutic effect in treating chronic respiratory failure.Methods 40 double lung transplantations were conducted in Shanghai Chest Hospital from January 2003 to May 2012.There were 26 cases of idiopathic pulmonary fibrosis,6 cases of diffuse bronchiectsis,5 cases of COPD,1 case of silicosis,1 case of pulmonary lymphangioleiomyomatosis(LAM) and 1 case of primary pulmonary hypertension (PPH).36 cases were conducted with ECMO,2 cases with cardiopulmonary bypass(CPB),2 cases without CPB.Results 30 day motality rate was 10％ (4cases).The leading cause were intraoperative massive bleeding,graft failure and the secondary multiple organ disfunction.Average fo11ow-up time was 37 months (2-66 months).1-,3-,5-year survival rate were 65.0％ (26/40),55.0％ (22/40) and 42.5 ％ (17/40).Infection and bronchiolitis obliterans syndrome(BOS) are the main reason influence long term survival.In the recent 6 years,30 day mortality rate was 0.1,3 year survival rate was 83.3％ (25/30) and 70.0％ (21/30).Conclusion Double lung transplantion is technically highly demanded.However,with the increasing of our experience,it becomes a safe way to treat end stage lung disease.Comparing to single lung transplantation,double lung transplantation carrys out better quality of life and longer survival.
