Dromer C, Velly J F, Jougon J, Martigne C, Baudet E M, Couraud L
Service de Chirurgie Thoracique, Hôpital Xavier Arnozan, Pessac, France.
Ann Thorac Surg. 1993 Jul;56(1):68-72; discussion 73. doi: 10.1016/0003-4975(93)90403-5.
Between February 1988 and January 1992, 61 patients have undergone bilateral lung transplantations (42 heart-lung and 19 double-lung) in Bordeaux. The underlying diseases were primary or secondary hypertension (20), emphysema (22), or other diseases including cystic fibrosis, pulmonary fibrosis, silicosis, and sarcoidosis (19). Actuarial survival for double-lung and heart-lung transplant recipients was 66% and 72% at 1 year and 57% and 53% at 3 years, respectively. Forty-two patients were still alive 6 months after operation, and we studied their pulmonary function at the short and long term. All parameters except arterial carbon dioxide tension had improved dramatically at 6 months (p < 0.0001). Vital capacity, forced expiratory volume in 1 second, and forced expiratory flow rate between 25% and 75% of vital capacity were at 79% +/- 3%, 92% +/- 5%, and 105% +/- 8% of the predicted values, respectively. Arterial oxygen tension was 88 +/- 3 mm Hg. Nine months after operation, a slight decrease in forced expiratory volume in 1 second and forced expiratory flow rate between 25% and 75% of vital capacity appeared but values remained more than 75% predicted. This was related to the occurrence of obliterative bronchiolitis in 6 patients (14%). At 9 months, flow rates and oxygen tension of these 6 patients were highly different from those of patients free of obliterative bronchiolitis (p < 0.0002 for flow rates and p < 0.01 for oxygen tension). Only 1 patient required retransplantation. The others are living an almost normal life. Our results are discussed in view of the published reports on single-lung transplantation. Short-term results of bilateral lung transplantation are thus excellent and maintained on a long-term basis. Therefore, in our opinion, bilateral lung transplantation is the therapy of choice for pulmonary hypertension and emphysema.
1988年2月至1992年1月期间，61例患者在波尔多接受了双侧肺移植手术（42例心肺联合移植和19例双肺移植）。潜在疾病包括原发性或继发性高血压（20例）、肺气肿（22例），或其他疾病，如囊性纤维化、肺纤维化、矽肺和结节病（19例）。双肺移植和心肺联合移植受者的精算生存率在1年时分别为66%和72%，在3年时分别为57%和53%。42例患者术后6个月仍存活，我们对他们的肺功能进行了短期和长期研究。除动脉血二氧化碳分压外，所有参数在6个月时均有显著改善（p<0.0001）。肺活量、第1秒用力呼气量以及肺活量25%至75%之间的用力呼气流量分别为预测值的79%±3%、92%±5%和105%±8%。动脉血氧分压为88±3 mmHg。术后9个月，第1秒用力呼气量以及肺活量25%至75%之间的用力呼气流量略有下降，但仍超过预测值的75%。这与6例患者（14%）发生闭塞性细支气管炎有关。在9个月时，这6例患者的流量和氧分压与未发生闭塞性细支气管炎的患者有很大差异（流量p<0.0002，氧分压p<0.01）。只有1例患者需要再次移植。其他患者过着几乎正常的生活。我们结合已发表的关于单肺移植的报告对结果进行了讨论。双侧肺移植的短期结果非常好，并且能长期维持。因此，我们认为，双侧肺移植是肺动脉高压和肺气肿的首选治疗方法。
