Wisser W, Deviatko E, Simon-Kupilik N, Senbaklavaci O, Huber E R, Wolner E, Klepetko W
Department of Cardiothoracic Surgery, University of Vienna, Austria.
J Heart Lung Transplant. 2000 May;19(5):480-7. doi: 10.1016/s1053-2498(00)00085-1.
Lung volume reduction surgery (LVRS) has been proposed as a possible alternative treatment to lung transplantation (LTX) for selected patients with end-stage emphysema. But whether LVRS is a temporary or permanent alternative to LTX is still under investigation. The aim of this study was to analyze the course of patients undergoing LVRS followed by subsequent LTX.
Fifteen patients (10 male, 5 female, mean age 53.3 +/- 1.7 years) out of 102 patients, who underwent LVRS between September 1994 and August 1998, underwent LTX 19.6 +/- 3.1 months after LVRS (range 1.7 to 37.6 months) between June 1996 and October 1998. In 9 patients bilateral LVRS was performed, in 6 patients unilateral LVRS. Subsequent LTX was performed bilaterally in 10 patients and unilaterally in 5 patients (1 of these on the contralateral side) to the previous LVRS. The course of lung function and clinical outcome were analyzed in these 15 patients.
Mean forced expiratory volume in 1 second (FEV(1)) in the 15 patients prior to LVRS was 18.3 +/- 1.2% of predicted (%p) and increased to 27.0 +/- 2.9 %p (best value within the first 6 months postLVRS) (p = 0.043). In 8 of these patients (non-responders) (53%) LVRS failed to improve FEV(1), whereas in the other 7 patients (responders) (47%) a significant improvement was detected (FEV(1) 18.1 +/- 1.8 %p and 31.9 +/- 3.7 %p, pre- and post-LVRS, respectively, p = 0.003), but declined after 6 to 36 months. At the time of listing for LTX the mean FEV(1) was 18.0 +/- 1.9 %p (no difference between the 2 groups). LTX was performed 15.5 +/- 3.6 months (non-responders) and 25.7 +/- 4.6 months (responders) after LVRS. FEV(1) improved to 81.0 +/- 5.6 %p after LTX (p < 0.001 compared to pre-LTX). The mortality after LVRS was 0%. The 3-month mortality after LTX was 20% (1 patient with primary organ failure, 1 patient with ongoing rejection, 1 patient with sepsis). All 3 patients belonged to the group of nonresponders. Two patients died 5. 5 and 8.5 months after LTX (13.3%) due to fungal infection (Aspergillus spp.) and MRSA sepsis, respectively (1 non-responder, 1 responder).
Successful LVRS delays the need for LTX and offers better conditions for LTX. However, patients without functional improvement after LVRS have a high perioperative risk at subsequent LTX.
对于部分终末期肺气肿患者，肺减容手术（LVRS）已被提议作为肺移植（LTX）的一种可能替代治疗方法。但LVRS是LTX的临时还是永久替代方法仍在研究中。本研究的目的是分析接受LVRS后继而接受LTX患者的病程。
在1994年9月至1998年8月期间接受LVRS的102例患者中，有15例患者（10例男性，5例女性，平均年龄53.3±1.7岁）在1996年6月至1998年10月期间，于LVRS后19.6±3.1个月（范围1.7至37.6个月）接受了LTX。9例患者接受了双侧LVRS，6例患者接受了单侧LVRS。随后的LTX中，10例患者为双侧手术，5例患者为单侧手术（其中1例在与先前LVRS相反的一侧）。分析了这15例患者的肺功能进程和临床结局。
15例患者在LVRS前的平均第1秒用力呼气容积（FEV(1)）为预测值的18.3±1.2%（%p），并增加至27.0±2.9 %p（LVRS后前6个月内的最佳值）（p = 0.043）。这些患者中有8例（无反应者）（53%）LVRS未能改善FEV(1)，而其他7例患者（有反应者）（47%）则有显著改善（LVRS前后的FEV(1)分别为18.1±1.8 %p和31.9±3.7 %p，p = 0.003），但在6至36个月后下降。在列入LTX名单时，平均FEV(1)为18.0±1.9 %p（两组之间无差异）。LVRS后15.5±3.6个月（无反应者）和25.7±4.6个月（有反应者）进行了LTX。LTX后FEV(1)改善至81.0±5.6 %p（与LTX前相比，p < 0.001）。LVRS后的死亡率为0%。LTX后3个月的死亡率为20%（1例原发性器官衰竭，1例持续性排斥反应，1例败血症）。所有3例患者均属于无反应者组。2例患者在LTX后5.5和8.5个月（13.3%）分别因真菌感染（曲霉菌属）和耐甲氧西林金黄色葡萄球菌败血症死亡（1例无反应者，1例有反应者）。
成功的LVRS可延迟LTX的需求，并为LTX提供更好的条件。然而，LVRS后无功能改善的患者在随后的LTX中有较高的围手术期风险。
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