Cantu Edward, Appel James Z, Hartwig Matthew G, Woreta Hiwot, Green Cindy, Messier Robert, Palmer Scott M, Davis R Duane
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Ann Thorac Surg. 2004 Oct;78(4):1142-51; discussion 1142-51. doi: 10.1016/j.athoracsur.2004.04.044.
Chronic allograft dysfunction limits the long-term success of lung transplantation. Increasing evidence suggests nonimmune mediated injury such as due to reflux contributes to the development of bronchiolitis obliterans syndrome. We have previously demonstrated that fundoplication can reverse bronchiolitis obliterans syndrome in some lung transplant recipients with reflux. We hypothesized that treatment of reflux with early fundoplication would prevent bronchiolitis obliterans syndrome and improve survival.
A retrospective analysis of 457 patients who underwent lung transplantation from April 1992 through July 2003 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (< 90 days) fundoplication and history of reflux and late fundoplication.
Incidence of postoperative reflux was 76% (127 of 167 patients) in pH confirmed subgroups. In 14 patients with early fundoplication, actuarial survival was 100% at 1 and 3 years when compared with those with reflux and no intervention (92% +/- 3.3, 76% +/- 5.8; p < 0.02). Further, those who underwent early fundoplication had improved freedom from bronchiolitis obliterans syndrome at 1 and 3 years (100%, 100%) when compared with no fundoplication in patients with reflux (96% +/- 2.5, 60% +/- 7.5; p < 0.01).
Reflux is a frequent medical complication after lung transplantation. Although the number of patients undergoing early fundoplication is small, our results suggest early aggressive surgical treatment of reflux results in improved rates of bronchiolitis obliterans syndrome and survival. Further research into the mechanisms and treatment of nonalloimmune mediated lung allograft injury is needed to reduce rates of chronic lung failure.
慢性移植物功能障碍限制了肺移植的长期成功。越来越多的证据表明，诸如反流等非免疫介导的损伤会导致闭塞性细支气管炎综合征的发生。我们之前已经证明，胃底折叠术可以使一些患有反流的肺移植受者的闭塞性细支气管炎综合征得到逆转。我们假设早期进行胃底折叠术治疗反流可以预防闭塞性细支气管炎综合征并提高生存率。
对1992年4月至2003年7月间接受肺移植的457例患者进行回顾性分析。患者被分为四组：无反流病史、有反流病史、有反流病史且早期（<90天）行胃底折叠术、有反流病史且晚期行胃底折叠术。
在pH值确诊的亚组中，术后反流发生率为76%（167例患者中的127例）。在14例早期行胃底折叠术的患者中，1年和3年的精算生存率为100%，而有反流但未干预的患者分别为92%±3.3、76%±5.8；p<0.02。此外，与有反流但未行胃底折叠术的患者相比，早期行胃底折叠术的患者在1年和3年时无闭塞性细支气管炎综合征的比例更高（分别为100%、100%），后者分别为96%±2.5、60%±7.5；p<0.01。
反流是肺移植后常见的医学并发症。虽然早期行胃底折叠术的患者数量较少，但我们的结果表明，早期积极的反流手术治疗可提高闭塞性细支气管炎综合征的发生率和生存率。需要进一步研究非同种异体免疫介导的肺移植损伤机制及治疗方法，以降低慢性肺衰竭的发生率。
