摘要
目的探讨肺移植治疗终末期肺疾病的效果，并对单中心肺移植的经验进行总结。方法回顾2003年1月至2012年12月间52例肺移植病例的临床资料，受者年龄为24-76岁，≥65岁者13例；受者原发病主要为肺气肿33例（63．5％）及特发性肺间质纤维化8例（15．4％）。术后对所有受者的并发症发生率、死亡情况及存活率进行分析。结果供肺缺血时间〉6h者28例（53．8％），其中缺血超过10h者20例（38．5％）。术后出现吻合口狭窄3例（5．8％），住院期间发生细菌感染14例（26．9％），真菌感染13例（25．0％），巨细胞病毒性肺炎1例（1．9%）。发生急性排斥反应20例（38．5％），经甲泼尼龙冲击治疗3d后均逆转；发生慢性排斥反应7例（13．5％），其中2例接受再次肺移植后效果良好，3例调整免疫抑制方案后缓解，2例死亡。术后1年内死亡9例（17．3％），术后1、3和5年的总体累积存活率分别为81．4％，54．5％和30．9％。结论肺移植是治疗终末期肺疾病的有效方法，恰当的病例选择、良好的肺保护、正确的围手术期处理及系统的术后管理是肺移植成功的关键。
Objective To summarize the experience in lung transplantation for end-stage lung diseases in a single center. Methods Fifty-two patients with end-stage lung diseases underwent lung transplantation between January 2003 and December 2012. Their ages ranged from 24 years to 76 years, and 13 cases （25.0%） were older than 65 years. The top two diseases for lung transplantation were emphysema in 33 cases （63.5%） and idiopathic pulmonary fibrosis in 8 cases （15.4%）. Their clinical data were analyzed retrospectively. Results Of the 52 patients, 28 cases （53. 8%） experienced ischemic time over 6 h, and 20 cases over 10 h. Postoperative complications included anastomotic stenosis in 3 patients （5.8%）, bacteria infection in 14 patients （26. 9%）, fungal infection in 13 patients （25. 0%）, and CMV pneumonia in 1 patient （1.9%）. Acute rejections were diagnosed in 20 patients （38. 5%）, while chronic rejections occurred in 7 patients （13. 5%）. Of the 7 cases of chronic rejection, 2 cases （3. 8 % ） underwent lung re-transplantation, 2 patients （3. 8 % ） were relieved by adjustment of anti-rejection drugs, and 2 patients （3.8%） died. Nine patients （17. 3%） died in early term postoperatively. The 1-, 3- and 5-year survival rate was 81.4%, 54.5%, and 30.9%, respectively. Conclusion Lung transplantation is an effective treatment for end-stage lung diseases. Carefully selecting recipients, well protecting graft lung, proper peri-operative treatment and systematic management after discharge are the key steps leading to successful lung transplantation.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2013年第3期155-158,共4页
Chinese Journal of Organ Transplantation
基金
基金项目：广州市医药卫生科技项目（2009-YB145）
关键词
肺移植
肺疾病
Lung transplantation
Lung diseases
