Dosanjh A, Jones L, Yuh D, Robbins R C
Department of Pediatrics, Stanford University School of Medicine, California, USA.
Pediatr Transplant. 1998 Nov;2(4):283-7.
Cystic fibrosis (CF) is associated with varying degrees of pleural inflammatory reaction that occurs as a result of chronic pulmonary infections and intervention to pleural space. The amount of pleural reaction is associated with the difficulty involved when performing the pneumonectomy at the time of lung replacement. The aim of this study is to identify possible pre-transplantation parameters that may predict the extent of pleural adhesion density. The charts of the 32 CF patients who underwent lung transplantation were reviewed. The degree of pleural adhesions was graded as none, minimal, moderate or severe, by extensive retrospective chart review of the operative and pathology reports. Available Brasfield radiographic scores, chest computerized tomographic (CT) scan scores, and pulmonary function test results were correlated to the pleural density grades. CT scans were scored by one radiologist as none, mild focal, moderate focal, diffuse mild or severe pleural disease. The presence of severe adhesions was associated with lower diffusion capacity corrected for volume (DL(CO)/VA) (p=0.0022) and older age (p<0.05) at the time of transplant. The typical radiographic and pulmonary function findings of airway obstruction, parenchymal nodularity and air trapping did not correlate with pleural adhesion density. The eleven patients with severe pleural adhesions had a longer ICU course and remained intubated longer than the thirteen patients with none or minimal adhesions. The extent of severe adhesions associated with CF cannot be predicted by preoperative Brasfield radiographic scores of parenchymal disease or spirometry data. However, chest CT imaging and DL(CO)/VA measurements may be useful in predicting the extent of pleural adhesions and the degree of dissection difficulty associated with the pneumonectomies for lung transplantation in the CF recipients.
囊性纤维化（CF）与不同程度的胸膜炎症反应相关，这种反应是由慢性肺部感染和对胸膜腔的干预引起的。胸膜反应的程度与肺移植时进行肺切除术的难度有关。本研究的目的是确定可能预测胸膜粘连密度程度的移植前参数。回顾了32例接受肺移植的CF患者的病历。通过对手术和病理报告进行广泛的回顾性图表审查，将胸膜粘连程度分为无、轻度、中度或重度。将可用的布拉斯菲尔德放射学评分、胸部计算机断层扫描（CT）扫描评分和肺功能测试结果与胸膜密度分级相关联。由一名放射科医生对CT扫描进行评分，分为无、轻度局灶性、中度局灶性、弥漫性轻度或重度胸膜疾病。严重粘连的存在与移植时较低的经容积校正的弥散能力（DL(CO)/VA）（p = 0.0022）和较高的年龄（p < 0.05）相关。气道阻塞、实质结节和空气潴留的典型放射学和肺功能表现与胸膜粘连密度无关。11例有严重胸膜粘连的患者在重症监护病房（ICU）的病程更长，插管时间也比13例无或轻度粘连的患者更长。CF相关的严重粘连程度无法通过术前实质疾病的布拉斯菲尔德放射学评分或肺量计数据来预测。然而，胸部CT成像和DL(CO)/VA测量可能有助于预测CF受者肺移植肺切除术中胸膜粘连的程度和解剖难度。
