Mao Wen-jun, Zhang Ying-ming, Chen Jing-yu, Zheng Ming-feng
Department of Thoracic Surgery, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi 214023, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2011 Oct;29(10):746-50.
To explore the therapeutic effects of lung transplantation (LTx) and whole lung lavage (WLL) for patients with end-stage pneumoconiosis.
From June 2002 to February 2011, 5 cases with end-stage pneumoconiosis were treated with LTx and 12 cases with end-stage pneumoconiosis were treated with WLL. The clinical symptoms, pulmonary functions, pulmonary artery pressures, blood gas analysis, imagings of chest and survival status were retrospectively analyzed.
In LTx group, the clinical symptoms (cough, sense of suppression in the chest), pulmonary functions and blood gas indicators were improved, pulmonary artery pressures decreased to normal levels, the imaging of chest showed that the implanted lung inflated well and was with clear lung markings. But the contralateral lungs without treatment appeared the progression of disease in the imaging of chest. In WLL group, the clinical symptoms in a half year after treatment were improved but the symptomatic relief rate declined with time, the pulmonary functions in half year after treatment were improved but decreased after 2 years, the pulmonary artery hypertension enhanced generally, as compared with that prior to WLL. The disease progression in the chest imaging examination was not found in a half year after WLL, but appeared in 1 ∼ 2 years after WLL. During following-up. the mean survival times in LTx and WLL groups were 40.5 and 21.4 months, respectively. In LTx group, one patient died of multiple organ dysfunctions (MODS) caused by primary graft dysfunction (PGD), one case died of severe infection in seven months after LTx. Up to now, other 3 cases have survived for 65, 41 and 29 months, respectively. In WLL group, 3 cases died of pulmonary infection, 2 cases died of respiratory failure, one case died of heart failure and one case died of encephalon vascular accident, the mean survival time of these 7 patients was (19.0 ± 8.7) months. So far other 5 cases have survived for 7, 9, 13, 18 and 26 months, respectively.
LTx has greater risk of death during preoperative period, but patients after LTx may have long survival times with good quality of life. The clinical symptoms and pulmonary functions of patients can be improved temporarily after WLL, but the survival time of WLL is inferior to that of LTx.
探讨肺移植（LTx）和全肺灌洗（WLL）治疗晚期尘肺病患者的疗效。
2002年6月至2011年2月，对5例晚期尘肺病患者行肺移植治疗，12例晚期尘肺病患者行全肺灌洗治疗。回顾性分析患者的临床症状、肺功能、肺动脉压、血气分析、胸部影像学及生存状况。
肺移植组患者的临床症状（咳嗽、胸闷感）、肺功能及血气指标均有改善，肺动脉压降至正常水平，胸部影像学显示植入肺膨胀良好，肺纹理清晰。但未治疗的对侧肺在胸部影像学上出现病情进展。全肺灌洗组患者治疗后半年临床症状有所改善，但症状缓解率随时间下降，治疗后半年肺功能有所改善，但2年后下降，肺动脉高压总体升高，与灌洗前相比。全肺灌洗后半年胸部影像学检查未见病情进展，但灌洗后1～2年出现。随访期间，肺移植组和全肺灌洗组的平均生存时间分别为40.5个月和21.4个月。肺移植组1例患者死于原发性移植功能障碍（PGD）引起的多器官功能障碍（MODS），1例患者在肺移植后7个月死于严重感染。截至目前，其他3例患者分别存活65、41和29个月。全肺灌洗组3例患者死于肺部感染，2例患者死于呼吸衰竭，1例患者死于心力衰竭，1例患者死于脑血管意外，这7例患者的平均生存时间为（19.0±8.7）个月。截至目前，其他5例患者分别存活7、9、13、18和26个月。
肺移植术前死亡风险较大，但肺移植术后患者可能生存时间长，生活质量良好。全肺灌洗后患者的临床症状和肺功能可暂时改善，但全肺灌洗的生存时间低于肺移植。
