肺减容手术后行肺移植的结果：一项匹配队列研究。

Outcomes of lung volume reduction surgery followed by lung transplantation: a matched cohort study.

作者信息

Burns Karen E A, Keenan Robert J, Grgurich Wayne F, Manzetti Jan D, Zenati Marco A

机构信息

Division of Pulmonary Transplantation, The University of Pittsburgh Medical Center, Pennsylvania, USA.

出版信息

Ann Thorac Surg. 2002 May;73(5):1587-93. doi: 10.1016/s0003-4975(02)03499-9.

DOI:10.1016/s0003-4975(02)03499-9

PMID:12022555

Abstract

BACKGROUND

Lung volume reduction surgery (LVRS) has been demonstrated to provide symptomatic relief and to improve lung function in patients with end-stage emphysema. The goal of this study was to assess the additional morbidity associated with lung transplantation after LVRS for end-stage emphysema with regard to immediate postoperative outcomes, longitudinal spirometry, and survival rates compared to an age-, gender-, procedure-matched, and transplant time-matched cohort that had lung transplantation alone.

METHODS

We compared the postoperative and long-term outcomes of a sequential procedure cohort to a matched cohort to assess the possible added post-transplant morbidity.

RESULTS

Fifteen patients who underwent sequential LVRS (including 11 unilateral LVRS, 4 bilateral LVRS) and lung transplantation (ipsilateral in 7 and contralateral in 8) on average 28.1 +/- 17.2 months (median, 27.4 months; range, 3.7 to 61.7 months) later were assessed. No significant differences were noted in pretransplant demographics, post-transplant variables, longitudinal spirometric indices, or survival. A trend toward a lower pretransplant arterial carbon dioxide tension was apparent in the sequential procedure cohort. Group analysis revealed a significant increase in the number of patients requiring transfusion and in the total number of units transfused in patients undergoing ispsilateral transplantation after LVRS; a significant increase in the length of intensive care unit stay; and a trend toward an increase in the duration of hospital stay in patients undergoing lung transplantation within 18 months of LVRS.

CONCLUSIONS

In appropriate candidates, LVRS bridged the time to transplantation by an average of 28.1 +/- 17.2 months (median, 27.4 months; range, 3.7 to 61.7 months) without significantly increasing post-transplant morbidity or mortality. Furthermore, bilateral LVRS bridged the time to transplantation to a greater extent than unilateral LVRS (34.9 +/- 29.8 months; median, 32.1 months versus 25.4 +/- 16.3 months; median, 22.3 months; p = 0.23).

摘要

背景

肺减容手术（LVRS）已被证明能缓解终末期肺气肿患者的症状并改善其肺功能。本研究的目的是评估终末期肺气肿患者在接受LVRS后进行肺移植所带来的额外发病率，具体涉及术后即刻结局、纵向肺功能测定以及生存率，并与仅接受肺移植的年龄、性别、手术方式匹配且移植时间匹配的队列进行比较。

方法

我们将序贯手术队列的术后和长期结局与匹配队列进行比较，以评估移植后可能增加的发病率。

结果

对15例接受序贯LVRS（包括11例单侧LVRS和4例双侧LVRS）并平均在28.1±17.2个月（中位数为27.4个月；范围为3.7至61.7个月）后接受肺移植（7例为同侧移植，8例为对侧移植）的患者进行了评估。在移植前人口统计学、移植后变量、纵向肺功能指标或生存率方面未发现显著差异。序贯手术队列中移植前动脉二氧化碳分压有降低趋势。分组分析显示，LVRS后接受同侧移植的患者中，需要输血的患者数量和输血总量显著增加；重症监护病房住院时间显著延长；LVRS后18个月内接受肺移植的患者住院时间有增加趋势。

结论

对于合适的患者，LVRS平均可将移植时间延长28.1±17.2个月（中位数为27.4个月；范围为3.7至61.7个月），且不会显著增加移植后发病率或死亡率。此外，双侧LVRS比单侧LVRS在更大程度上延长了移植时间（34.9±29.8个月；中位数为32.1个月，而单侧为25.4±16.3个月；中位数为22.3个月；p = 0.23）。