Souilamas Rédha, Saueressig Mauricio, Boussaud Véronique, Amrein Catherine, Guillemain Romain, Sonett Joshua
Thoracic Surgery and Lung Transplant Department, European Georges Pompidou, Paris, France.
Asian Cardiovasc Thorac Ann. 2011 Jun;19(3-4):202-6. doi: 10.1177/0218492311409242.
Pulmonary resection after lung transplantation in end-stage cystic fibrosis presents unique challenges, and scant literature exists to guide physicians. We retrospectively reviewed 78 transplants for cystic fibrosis performed between 2003 and 2008. Fourteen patients underwent posttransplantation pulmonary resection. We analyzed the indications, surgical procedures, outcomes, and survival. Three pneumonectomies, 4 lobectomies, and 11 wedge resections were carried out. We identified 2 groups based on indication: a diagnostic group, and a therapeutic group of patients in whom the indications were septic native lung in 2, allograft infection in 2, lobar torsion in 2, pulmonary infarction in 2, and size mismatch in 4. The mean intensive care unit and hospital stays were 29 and 50 days, respectively. Four (28.57%) patients died during follow-up, including 2 who underwent pneumonectomy; 10 (71.43%) are still alive. Survival was 43.43 ± 8.06 months, and it was not significantly different from that in cystic fibrosis patients who had lung transplantation without pulmonary resection. Pulmonary resection following lung transplantation in cystic fibrosis patients showed acceptable survival and surgical risk, but metachronous pneumonectomy was associated with higher mortality.
终末期囊性纤维化患者肺移植后行肺切除术面临独特挑战，且指导医生的文献匮乏。我们回顾性分析了2003年至2008年间进行的78例囊性纤维化肺移植病例。14例患者接受了移植后肺切除术。我们分析了手术指征、手术方式、手术结果及生存率。共进行了3例全肺切除术、4例肺叶切除术和11例楔形切除术。根据手术指征，我们将患者分为两组：诊断组和治疗组，治疗组患者的手术指征包括2例自体肺感染、2例移植肺感染、2例肺叶扭转、2例肺梗死以及4例大小不匹配。患者在重症监护病房和医院的平均住院时间分别为29天和50天。4例（28.57%）患者在随访期间死亡，其中2例行全肺切除术；10例（71.43%）患者仍存活。患者的生存时间为43.43±8.06个月，与未行肺切除术的囊性纤维化肺移植患者相比，差异无统计学意义。囊性纤维化患者肺移植后行肺切除术显示出可接受的生存率和手术风险，但二期全肺切除术与较高的死亡率相关。
