Mendogni Paolo, Palleschi Alessandro, Grisorio Giacomo, Mazzucco Alessandra, Diotti Cristina, Morlacchi Letizia Corinna, Rosetti Valeria, Bonitta Gianluca, Nosotti Mario, Rosso Lorenzo
Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS Cà Granda Ospedale maggiore Policlinico, Milan, Italy.
Departament of Physiopathology and Transplantation, University of Milan, Milan, Italy.
Clin Transplant. 2024 Dec;38(12):e70054. doi: 10.1111/ctr.70054.
Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation (LuTx). Some cases may present severe chest asymmetry because of recurrent infections or previous surgical procedures, and the most used surgical options are single LuTx and contralateral pneumonectomy or bilateral transplantation with graft downsizing. Our purpose is to evaluate our treatment protocols for these patients and review surgical strategies reported by others. We prospectively collected clinical data of patients with significant pleural cavity asymmetry who underwent bilateral LuTx at our center from 2017 to 2022. Clinical reports of all patients who underwent LuTx for end-stage suppurative disease in the same period were reviewed as the control group. During the study period, 74 patients underwent bilateral LuTx for suppurative disease; seven of them presented with severe thoracic asymmetry, and all of them were extubated by the second postoperative day. The mean intensive care unit stay was 4 days. The postoperative radiological evaluation did not show clustering or atelectasis of the graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of stay was 23 days. The perioperative course appeared remarkably good, and both the short- and long-term follow-up were similar to that of the control group.
导致终末期呼吸衰竭的化脓性肺部疾病是双侧肺移植（LuTx）的典型适应症。一些病例可能因反复感染或既往手术而出现严重的胸部不对称，最常用的手术选择是单肺移植和对侧肺切除术或缩小移植物的双侧移植。我们的目的是评估我们针对这些患者的治疗方案，并回顾其他人报道的手术策略。我们前瞻性地收集了2017年至2022年在我们中心接受双侧肺移植且胸腔明显不对称的患者的临床数据。将同期所有因终末期化脓性疾病接受肺移植的患者的临床报告作为对照组。在研究期间，74例患者因化脓性疾病接受了双侧肺移植；其中7例出现严重胸廓不对称，所有患者均在术后第二天拔管。重症监护病房平均住院时间为4天。术后影像学评估未显示植入较小半侧胸腔的移植物出现聚集或肺不张。未记录围手术期重大并发症，平均住院时间为23天。围手术期过程明显良好，短期和长期随访结果与对照组相似。
