Trulock E P, Cooper J D, Kaiser L R, Pasque M K, Ettinger N A, Dresler C M
General Thoracic Surgery Section, Washington University School of Medicine, St Louis, MO 63110.
JAMA. 1991 Oct 9;266(14):1943-6.
--To review our experience with lung transplantation, emphasizing recipient selection, choice of procedure, functional results, and outcome.
--Retrospective review of patients who received lung transplants at Barnes Hospital, St Louis, Mo, between July 1, 1988, and January 31, 1991.
--Washington University School of Medicine, St Louis, Mo, and Barnes Hospital, a medical school and its affiliated referral hospital, respectively.
--Sixty-nine lung transplant procedures were performed in 66 recipients. Patients with clinically and physiologically severe lung disease were selected according to predetermined guidelines. Underlying diseases in the recipients included chronic obstructive pulmonary disease, alpha 1-antitrypsin deficiency emphysema, cystic fibrosis, pulmonary fibrosis, primary pulmonary hypertension, Eisenmenger's syndrome associated with an atrial septal defect, bronchiectasis, eosinophilic granuloma, and lymphangiomyomatosis.
--Double-lung, bilateral sequential, and single-lung transplantations were performed. Eight patients underwent en bloc double-lung transplantations or a modification of this procedure with separate bronchial anastomoses. Thereafter, the bilateral sequential approach to replacement of both lungs was performed in 26 patients. Thirty-two patients underwent single-lung transplantations.
--Pulmonary function tests, arterial blood gas levels, pulmonary artery pressure, pulmonary vascular resistance, and actuarial survival.
--Actuarial survival at 1 year for the 66 lung transplant recipients was 79%. Actuarial survival at 1 year was 82% for the bilateral lung transplant recipients and was 90% for the single-lung transplant recipients. In patients with either restrictive or obstructive lung disease, pulmonary function tests and arterial blood gas levels improved markedly after lung transplantation. In patients with primary pulmonary hypertension or Eisenmenger's syndrome, the pulmonary artery pressure decreased and the cardiac index increased into the normal range after single-lung transplantation.
--In carefully selected patients with end-stage lung disease, single-lung and bilateral lung transplantations can significantly improve functional capacity, with promising early actuarial survival statistics after 1 year.
回顾我们肺移植的经验，重点关注受者选择、手术方式选择、功能结果及预后。
对1988年7月1日至1991年1月31日期间在密苏里州圣路易斯市巴恩斯医院接受肺移植的患者进行回顾性研究。
密苏里州圣路易斯市华盛顿大学医学院及巴恩斯医院，分别为一所医学院及其附属转诊医院。
66例受者接受了69次肺移植手术。根据预定指南选择临床和生理上患有严重肺部疾病的患者。受者的基础疾病包括慢性阻塞性肺疾病、α1-抗胰蛋白酶缺乏性肺气肿、囊性纤维化、肺纤维化、原发性肺动脉高压、与房间隔缺损相关的艾森曼格综合征、支气管扩张症、嗜酸性肉芽肿和淋巴管平滑肌瘤病。
进行了双肺、双侧序贯和单肺移植。8例患者接受了整块双肺移植或采用单独支气管吻合术的改良手术。此后，26例患者采用双侧序贯法进行双肺置换。32例患者接受了单肺移植。
肺功能测试、动脉血气水平、肺动脉压力、肺血管阻力和精算生存率。
66例肺移植受者1年精算生存率为79%。双侧肺移植受者1年精算生存率为82%，单肺移植受者为90%。在患有限制性或阻塞性肺病的患者中，肺移植后肺功能测试和动脉血气水平显著改善。在患有原发性肺动脉高压或艾森曼格综合征的患者中，单肺移植后肺动脉压力下降，心脏指数升至正常范围。
在精心挑选的终末期肺病患者中，单肺和双肺移植可显著改善功能能力，1年后早期精算生存统计数据良好。
