肺减容手术后成功的肺移植。

Shitrit D, Fink G, Sahar G, Eidelman L, Saute M, Kramer M R

Pulmonary Institute,, Rabin Medical Center, Petah Tiqwa, Israel.

Thorac Cardiovasc Surg. 2003 Oct;51(5):274-6. doi: 10.1055/s-2003-43087.

BACKGROUND

Lung volume reduction surgery (LVRS) is an accepted treatment modality for patients with advanced emphysema. Recently, successful lung transplantation (LTX) has been reported following LVRS. We assess the pulmonary functions in lung transplant recipients after LVRS.

METHODS

8 patients - 5 males and 3 women--aged 53-66 years with advanced emphysema underwent LVRS. Following clinical deterioration and decline of pulmonary function, patients underwent single LTX. Post transplantation follow-up included pulmonary function, 6 minute walk distance (6 MWD) and recording perioperative complications.

RESULTS

Median forced expiratory in one second (FEV 1) before and after LVRS were 24 % with 31 % predicted, respectively. All but one showed improvement in lung function and 6 MWD following LVRS. Median maximal 6 MWD before and after LVRS was 222 and 316 meters, respectively. Median time from LVRS to LTX was 46 months (range 10-83). All patients survived and were discharged after LTX. Median FEV1 before and after LTX was 23 % with 57 % predicted, respectively. Median 6MWD before and after LTX was 240 and 462 meters, respectively. NYHA classes improved from 3-4 to 1-2 in 7 surviving patients. At transplantation, bleeding due to pleural adhesions was observed in 4 patients; two required blood transfusions. One patient developed acute respiratory distress syndrome and one had unilateral vocal cord paralysis. At nine-month follow-up, 7 patients are doing remarkably well, while one patient died 6 months after LTX due to bronchiolitis obliterans syndrome (BOS).

CONCLUSIONS

LVRS is a therapeutic option in patients with end-stage emphysema. When emphysema deteriorates, LTX can be successfully performed with significant improvement of quality of life without significant additional risk.

背景

肺减容手术（LVRS）是晚期肺气肿患者公认的治疗方式。最近，有报道称LVRS后成功进行了肺移植（LTX）。我们评估了LVRS后肺移植受者的肺功能。

方法

8例年龄在53 - 66岁的晚期肺气肿患者（5例男性，3例女性）接受了LVRS。在临床病情恶化和肺功能下降后，患者接受了单肺移植。移植后的随访包括肺功能、6分钟步行距离（6MWD）以及记录围手术期并发症。

结果

LVRS前后一秒用力呼气量（FEV1）的中位数分别为预计值的24%和31%。除1例患者外，所有患者LVRS后肺功能和6MWD均有改善。LVRS前后6MWD的最大中位数分别为222米和316米。从LVRS到LTX的中位时间为46个月（范围10 - 83个月）。所有患者均存活并在LTX后出院。LTX前后FEV1的中位数分别为预计值的23%和57%。LTX前后6MWD的中位数分别为240米和462米。7例存活患者的纽约心脏协会（NYHA）心功能分级从3 - 4级改善至1 - 2级。移植时，4例患者因胸膜粘连出现出血；2例需要输血。1例患者发生急性呼吸窘迫综合征，1例出现单侧声带麻痹。在9个月的随访中，7例患者情况良好，1例患者在LTX后6个月因闭塞性细支气管炎综合征（BOS）死亡。