Wu Y-J, Lin C-C, Chang Y-M, Wang S-H, Lin Y-H, Lu H-I, Concejero A M, Chen C-L, Lin T-L
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2016 May;48(4):1036-40. doi: 10.1016/j.transproceed.2015.08.046.
Chest computed tomography (CT) as a primary screening method in candidates for living donor liver transplantation (LDLT) is not yet a standardized procedure. The aim of this study is to present our methods and result of evaluation of pulmonary small nodules (PSN) after CT as a primary screening tool.
A total of 360 primary adult LDLTs were performed between October 2009 and December 2012. The 37 candidates with PSNs found on CT were divided into two groups, with 23 patients in the group that was chest radiography (CXR) positive (+) and 14 in the group that was CXR negative (-).
The nodular size in the CXR (-) group was significantly smaller than in the CXR (+) group (3.86 ± 1.24 vs 7.56 ± 4.08, P = .004). The sensitivity of CT for PSN was 37/360 (10.28%), much higher than the 14/360 (3.89%) for CXR alone. A total of 27 patients underwent video-assisted thoracoscopic surgery for pathologic diagnosis, and 10 were diagnosed as having benign PSNs by stationary sizes on serial CT scans. In the CXR (-) group, there were 2 cases of malignancy, 3 tuberculosis (TB), 3 Cryptococcus, and 15 other benign PS. In the CXR (+) group, there were 1 malignancy, 3 TB, 4 Cryptococcus, and other 6 benign PSNs. Recurrent infection was not seen in the posttransplantation follow-up of 13 candidates with infections. Excluding the 3 malignant PSNs, the 34 candidates in both groups survived 100% for more than 2 years after LDLT.
To exclude malignancy and to diagnose infectious PSN for further treatment in a timely manner, chest CT should be used as the primary screening tool for asymptomatic candidates for LDLT.
胸部计算机断层扫描（CT）作为活体肝移植（LDLT）候选者的主要筛查方法，尚未成为标准化程序。本研究的目的是介绍我们将CT作为主要筛查工具后评估肺小结节（PSN）的方法及结果。
2009年10月至2012年12月期间共进行了360例成人初次LDLT。CT检查发现有PSN的37名候选者被分为两组，胸部X线摄影（CXR）阳性（+）组有23例患者，CXR阴性（-）组有14例患者。
CXR（-）组的结节大小明显小于CXR（+）组（3.86±1.24 vs 7.56±4.08，P = .004）。CT对PSN的敏感性为37/360（10.28%），远高于单纯CXR的14/360（3.89%）。共有27例患者接受了电视辅助胸腔镜手术进行病理诊断，10例通过连续CT扫描结节大小稳定被诊断为良性PSN。在CXR（-）组中，有2例恶性肿瘤、3例肺结核（TB）、3例隐球菌感染和15例其他良性PS。在CXR（+）组中，有1例恶性肿瘤、3例TB、4例隐球菌感染和其他6例良性PSN。13例感染候选者在移植后随访中未见反复感染。排除3例恶性PSN后，两组的34例候选者在LDLT后存活超过2年的比例为100%。
为了及时排除恶性肿瘤并诊断感染性PSN以便进一步治疗，胸部CT应作为无症状LDLT候选者的主要筛查工具。
