活体肺供者残肺容积和重量的放射学评估。
Radiologic evaluation for volume and weight of remnant lung in living lung donors.
机构信息
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
出版信息
J Thorac Cardiovasc Surg. 2013 Nov;146(5):1253-8. doi: 10.1016/j.jtcvs.2013.05.038. Epub 2013 Jul 13.
OBJECTIVE
Living-lung donors lose pulmonary function of a right or left lower lobe in exchange for a noble donation; however, Chen and colleagues reported postoperative pulmonary function of the donors was significantly better than the estimated values. The purpose of this study was to investigate if the improvement of postoperative pulmonary function is associated with hypertrophic phenomena of remnant lung.
METHODS
A total of 35 patients who underwent a right or left lower lobectomy for living-donor lobar lung transplantation in Kyoto University Hospital from 2008 to 2011 were evaluated by means of spirometry (forced vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide), and computed tomography scans both before and 1 year after the surgery. Postoperative predictions of pulmonary function and radiologic parameters were made based on the number of resected segments. The average radiologic density of the lung was determined as follows: (mean computed tomography number + 1000)/1000, and weight of the lung was calculated as follows: lung volume (mL) × average radiologic lung density (g/mL). The radiologic analysis was performed on both the surgical and contralateral sides.
RESULTS
Postoperative forced vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide were significantly higher than estimated values by 17.3% ± 10.2% (P < .0001), 14.7% ± 10.2% (P < .0001), and 10.9% ± 16. % (P < .002), respectively. Postoperative lung volume and weight of the surgical side were significantly higher than estimated values by 54.4% ± 30.4% (P < .0001) and 28.1% ± 15.7% (P < .0001), respectively. On the contralateral side, the postoperative lung volume was significantly higher than the estimated value by 12.6% ± 15.3% (P < .0001), but postoperative weight was comparable with the estimated value (-2.3% ± 8.8%; P = .07).
CONCLUSIONS
Hypertrophic change of the ipsilateral remnant lung may be recognized in living lung donors.
目的
为了进行高尚的捐献，活体供肺者会失去右下肺叶或左下肺叶的肺功能；然而，Chen 及其同事报道活体供者术后的肺功能明显好于预估值。本研究的目的是探究术后肺功能的改善是否与残肺的增生现象相关。
方法
2008 年至 2011 年，京都大学医院对 35 例行右肺或左肺下叶切除术的活体供肺者进行了肺功能评估（用力肺活量、1 秒用力呼气量和一氧化碳弥散量），并在术前和术后 1 年进行了 CT 扫描。基于切除的节段数量，对术后肺功能和影像学参数进行了预测。肺的平均 CT 值被定义为（平均 CT 值+1000）/1000，肺的重量则通过肺容积（mL）×平均 CT 值（g/mL）来计算。手术侧和对侧均进行了影像学分析。
结果
术后的用力肺活量、1 秒用力呼气量和一氧化碳弥散量分别显著高于预测值 17.3%±10.2%（P<.0001）、14.7%±10.2%（P<.0001）和 10.9%±16.3%（P<.002）。手术侧的术后肺容积和肺重量分别显著高于预测值 54.4%±30.4%（P<.0001）和 28.1%±15.7%（P<.0001）。对侧的术后肺容积显著高于预测值 12.6%±15.3%（P<.0001），但术后肺重量与预测值相当（-2.3%±8.8%；P=0.07）。
结论
活体供肺者可能会出现同侧残肺的增生性改变。
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