成功的肺减容手术能使患者在后续肺移植时处于更好的状态。

Successful lung volume reduction surgery brings patients into better condition for later lung transplantation.

作者信息

Senbaklavaci Omer, Wisser Wilfried, Ozpeker Cenk, Marta Gabriel, Jaksch Peter, Wolner Ernst, Klepetko Walter

机构信息

Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

出版信息

Eur J Cardiothorac Surg. 2002 Sep;22(3):363-7. doi: 10.1016/s1010-7940(02)00354-8.

DOI:10.1016/s1010-7940(02)00354-8

PMID:12204724

Abstract

OBJECTIVES

Lung volume reduction surgery (LVRS) is accepted as a potential alternative therapy to lung transplantation (LTX) for selected patients. However, the possible impact of LVRS on a subsequent LTX has not been clearly elucidated so far. We therefore analyzed the course of 27 patients who underwent LVRS followed by LTX in our institution.

METHODS

Twenty-seven patients (11 male, 16 female, mean age 51.9+/-2.2 years) out of 119 patients who underwent LVRS between 1994 and 1999 underwent LTX 29.7+/-3.2 months (range 2-57 months) after LVRS. Based on the postoperative course of FeV1 after LVRS (best value within the first 6 months postoperatively compared with the preoperative value) patients were divided into two groups: Group A (n=11) without any improvement (FeV1 <20% increase), and Group B (n=16) with FeV1 increase > or = 20% after successful LVRS which declined to preoperative values after 8-42 months. Subsequent LTX was performed 22.9+/-5.6 months after LVRS in Group A and 34.3+/-4.9 months after LVRS in Group B (P<0.05). Patients were analyzed according to the course of their functional improvement and of their body mass index (BMI) after LVRS and to survival after LTX, respectively. Values are given as the mean+/-SEM and significance was calculated by the chi(2)-test whereas continuous values were estimated by Student's t-test.

RESULTS

Patients in Group A without improvement in FeV1 after LVRS had no increase in BMI as well and this resulted in a high perioperative mortality of 27.3% after LTX. On the contrary, patients in Group B, who had a clear increase of FeV1 after LVRS, experienced a significant increase of BMI of 23.2+/-4.5% as well (P<0.05). This improvement in BMI remained stable despite a later deterioration of FeV1 prior to LTX. After LTX, these patients had a significantly lower perioperative mortality of 6.3% as compared to Group A (P=0.03).

CONCLUSIONS

Successful LVRS delays the need for transplantation, improves nutritional status and brings patients into a better pretransplant condition, which results in decreased perioperative mortality at LTX. Patients after failed LVRS, however, should be considered as poor candidates for later transplantation.

摘要

目的

对于部分选定患者，肺减容手术（LVRS）被视为肺移植（LTX）的一种潜在替代疗法。然而，迄今为止，LVRS对后续LTX可能产生的影响尚未得到明确阐释。因此，我们分析了在我院接受LVRS后又接受LTX的27例患者的病程。

方法

1994年至1999年间接受LVRS的119例患者中，有27例（11例男性，16例女性，平均年龄51.9±2.2岁）在LVRS后29.7±3.2个月（范围2 - 57个月）接受了LTX。根据LVRS后第一秒用力呼气容积（FeV1）的术后病程（术后前6个月内的最佳值与术前值比较），患者被分为两组：A组（n = 11）无任何改善（FeV1增加<20%），B组（n = 16）在成功的LVRS后FeV1增加≥20%，但在8 - 42个月后降至术前值。A组在LVRS后22.9±5.6个月进行后续LTX，B组在LVRS后34.3±4.9个月进行后续LTX（P<0.05）。分别根据LVRS后功能改善过程、体重指数（BMI）以及LTX后的生存率对患者进行分析。数值以平均值±标准误表示，显著性通过卡方检验计算，连续数值通过学生t检验估算。

结果

LVRS后FeV1无改善的A组患者BMI也未增加，这导致LTX术后围手术期死亡率高达27.3%。相反，LVRS后FeV1明显增加的B组患者BMI也显著增加了23.2±4.5%（P<0.05）。尽管LTX前FeV1后来恶化，但BMI的这种改善仍保持稳定。LTX后，与A组相比，这些患者的围手术期死亡率显著降低，为6.3%（P = 0.03）。