Venuta F, Diso D, Anile M, Aratari M T, Francioni F, Pugliese F, Rendina E A, Coloni G F
Cattedra di Chirurgia Toracica, Policlinico Umberto I, Dipartimento di Chirurgia Paride Stefanini, Università di Roma, Rome, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2682-3. doi: 10.1016/j.transproceed.2005.06.038.
Lung transplantation is currently a suitable option for patients with end-stage lung disease. Since the early 1980s the surgical technique and immunosuppressive protocols have been progressively modified to improve results and favor long-term survival. The original heart-lung transplantation under cardiopulmonary bypass is now rarely performed and single or bilateral lung transplantation is the procedure of choice. Bilateral transplantation is performed with two single lung transplants performed in sequence. Extracorporeal support is rarely employed and in most cases it is instituted through the femoral approach. Also, the surgical approach has been modified and the original clam shell incision has been replaced by two small anterior thoracotomies. The use of marginal donors has been increasingly proposed to enlarge the number of organs potentially available for transplantation. Immunosuppressive protocols have evolved to patient-specific regimens that can be quickly modified if required by the clinical status. Induction is now more aggressive and also rescue protocols for obliterative bronchiolitis can contribute to improved outcomes. Overall, lung transplantation is now performed with encouraging long-term results.
肺移植目前是终末期肺病患者的一种合适选择。自20世纪80年代初以来，手术技术和免疫抑制方案已逐步改进，以改善治疗效果并有利于长期生存。最初在体外循环下进行的心肺移植如今很少施行，单肺或双肺移植是首选术式。双肺移植通过依次进行的两次单肺移植来完成。体外支持很少使用，在大多数情况下通过股动脉途径实施。此外，手术入路已得到改进，原来的蚌式切口已被两个小的前外侧开胸切口所取代。越来越多地提议使用边缘供体以增加潜在可用于移植的器官数量。免疫抑制方案已演变为针对患者的方案，可根据临床状况在需要时迅速调整。现在诱导治疗更为积极，针对闭塞性细支气管炎的挽救方案也有助于改善治疗结果。总体而言，目前肺移植的长期效果令人鼓舞。
