Van Raemdonck D, Verleden G, Coosemans W, Michiels E, De Leyn P, Buyse B, Demedts M, Lerut T
Department of Surgery, UZ Gasthuisberg, Leuven, Belgium.
Acta Chir Belg. 1994 Sep-Oct;94(5):245-57.
Lung transplantation nowadays has become a therapeutic modality in the treatment of patients with a variety of end-stage lung diseases. Between July 1991 and December 1992, twelve patients received an isolated lung transplant (eight single lungs and four double lungs) at the University Hospitals of Leuven. The indication for transplantation was emphysema in five patients, pulmonary fibrosis in three, cystic fibrosis in three and primary pulmonary hypertension in one. There were four early, in-hospital deaths (30%): two from sepsis and multi-organ failure, one from anoxia following a bronchial dehiscence and another patient exsanguinated following stent insertion for a partial bronchial dehiscence. Three more patients have died during follow-up: two from chronic respiratory failure secondary to the development of obliterative bronchiolitis (one at 8 months and one at 17 months), and one from a late bronchovascular fistula 4 months following transplantation. The overall actuarial one and two year-survival was 50.0% and 41.6% respectively. All patients discharged from hospital were oxygen free with an improved lung function and exercise capacity. We conclude that lung transplantation is a viable therapeutic option for selected patients with end-stage, irreversible lung disease. In our experience, the bronchial anastomosis remains an important keystone in the early success. Lung transplantation provides a good quality of life in patients free from infection and rejection. Nevertheless, chronic rejection resulting in obliterative bronchiolitis is a major problem in long-term survivors.
如今，肺移植已成为治疗各种终末期肺部疾病患者的一种治疗方式。1991年7月至1992年12月期间，12例患者在鲁汶大学医院接受了单肺移植（8例单肺移植和4例双肺移植）。移植的适应症为5例肺气肿、3例肺纤维化、3例囊性纤维化和1例原发性肺动脉高压。有4例早期院内死亡（30%）：2例死于败血症和多器官功能衰竭，1例死于支气管裂开后的缺氧，另1例患者在因部分支气管裂开插入支架后失血过多。在随访期间又有3例患者死亡：2例死于闭塞性细支气管炎发展继发的慢性呼吸衰竭（1例在8个月时，1例在17个月时），1例在移植后4个月死于晚期支气管血管瘘。总体精算1年和2年生存率分别为50.0%和41.6%。所有出院患者均无需吸氧，肺功能和运动能力均有所改善。我们得出结论，肺移植对于选定的终末期、不可逆肺部疾病患者是一种可行的治疗选择。根据我们的经验，支气管吻合术仍然是早期成功的一个重要关键因素。肺移植为无感染和排斥反应的患者提供了良好的生活质量。然而，导致闭塞性细支气管炎的慢性排斥反应是长期存活者的一个主要问题。
