Schwarz R E, Posner M C, Plunkett M B, Selby R R, Landreneau R J
Department of Surgery, University of Pittsburgh Medical Center, PA.
Clin Transplant. 1994 Aug;8(4):378-81.
Indeterminate pulmonary nodules (IPN) in transplant patients create a diagnostic and therapeutic challenge. Patients who are transplant candidates or have already undergone organ transplantation require diagnostic clarification of IPN which may represent oncologic and/or infectious disease processes. Between December 1991 and January 1993, we performed 43 needle-localized thoracoscopic resections (NLTR) on 40 patients for IPN considered too small for less invasive diagnostic techniques. Four of these patients were candidates for orthotopic liver transplantation (OLT) and required exclusion of either extrahepatic malignancy or pulmonary infection before proceeding with transplantation. The 5th patient had undergone OLT for an unresectable hepatocellular carcinoma, and NLTR confirmed the presence of pulmonary metastatic disease. Of the 4 OLT candidates, 2 had pathologically confirmed metastases from their primary hepatic malignancy and did not undergo transplantation. The remaining 2 OLT candidates had benign pulmonary processes (hamartoma, hyaline plaque) and underwent successful OLT. In all patients, the IPN was successfully identified with NLTR. There were no complications. NLTR is a reliable and well-tolerated method to diagnose IPN in transplant patients.
移植患者中的 indeterminate pulmonary nodules (IPN) 带来了诊断和治疗方面的挑战。作为移植候选者或已经接受器官移植的患者需要对 IPN 进行诊断性明确，其可能代表肿瘤和/或感染性疾病过程。在 1991 年 12 月至 1993 年 1 月期间，我们对 40 例患者进行了 43 次针定位胸腔镜切除术（NLTR），这些患者的 IPN 被认为对于侵入性较小的诊断技术来说太小。其中 4 例患者是原位肝移植（OLT）候选者，在进行移植前需要排除肝外恶性肿瘤或肺部感染。第 5 例患者因不可切除的肝细胞癌接受了 OLT，NLTR 证实存在肺转移瘤。在 4 例 OLT 候选者中，2 例经病理证实有原发性肝恶性肿瘤转移，未进行移植。其余 2 例 OLT 候选者有良性肺部病变（错构瘤、透明膜斑），并成功接受了 OLT。在所有患者中，NLTR 成功识别出 IPN。无并发症发生。NLTR 是诊断移植患者 IPN 的一种可靠且耐受性良好的方法。
