Sundaresan R S, Shiraishi Y, Trulock E P, Manley J, Lynch J, Cooper J D, Patterson G A
Department of Surgery, Washington University School of Medicine/Barnes Hospital, St. Louis, Mo., USA.
J Thorac Cardiovasc Surg. 1996 Dec;112(6):1485-94; discussion 1494-5. doi: 10.1016/s0022-5223(96)70007-7.
Most programs favor single lung transplantation for emphysema. However, this is controversial, and we have favored bilateral lung transplantation, confining single lung transplantation mainly to use in older patients and those of small stature.
A retrospective analysis was done of 119 consecutive lung transplantation procedures for emphysema at Barnes Hospital between 1989 and 1994 (50 single lung, 69 bilateral lung transplants) to (1) identify outcome differences between the two groups and (2) define the appropriate role of these two procedures.
The single lung transplantation group was older and had a higher proportion of female patients. However, baseline pulmonary function (forced expiratory volume in 1 second), arterial oxygen tension, and exercise tolerance (6-minute walk distance) were similar. After transplantation, 90-day mortality (single lung transplantation 10% versus bilateral lung transplantation 7.2%; p = 0.74) and duration of mechanical ventilation, intensive care unit stay, and hospitalization were similar. Both groups achieved a significant and sustained improvement in forced expiratory volume, arterial carbon dioxide tension, arterial oxygen tension, and exercise tolerance within 3 months. However, the improvements in forced expiratory volume, arterial oxygen tension, and exercise tolerance were consistently significantly better in recipients of bilateral transplants at and beyond 6 months. Obliterative bronchiolitis was equally prevalent in both groups. Survival was similar but showed a trend toward better late survival in recipients of bilateral transplants (5-year actuarial survival: bilateral lung transplantation 53% versus single lung transplantation 41%).
We conclude that (1) both procedures are satisfactory options in emphysema, producing durable results; (2) bilateral lung transplantation is not associated with increased operative mortality or morbidity and achieves superior improvements in spirometry findings, oxygenation, exercise tolerance, and possibly late survival; and (3) the superior improvements in function (and late survival) after bilateral lung transplantation may be attributed to the presence of more pulmonary reserve after the onset of obliterative bronchiolitis.
大多数项目倾向于对肺气肿患者进行单肺移植。然而，这存在争议，我们更倾向于双侧肺移植，主要将单肺移植用于老年患者和身材矮小的患者。
对1989年至1994年期间在巴恩斯医院连续进行的119例肺气肿肺移植手术（50例单肺移植，69例双侧肺移植）进行回顾性分析，以（1）确定两组之间的结果差异，以及（2）明确这两种手术的合适作用。
单肺移植组患者年龄更大，女性患者比例更高。然而，基线肺功能（第1秒用力呼气量）、动脉血氧张力和运动耐量（6分钟步行距离）相似。移植后，90天死亡率（单肺移植为10%，双侧肺移植为7.2%；p = 0.74）以及机械通气时间、重症监护病房停留时间和住院时间相似。两组在3个月内第1秒用力呼气量、动脉血二氧化碳张力、动脉血氧张力和运动耐量均有显著且持续的改善。然而，在6个月及以后，双侧移植受者的第1秒用力呼气量、动脉血氧张力和运动耐量的改善始终显著更好。闭塞性细支气管炎在两组中的发生率相同。生存率相似，但双侧移植受者的晚期生存率有更好的趋势（5年预期生存率：双侧肺移植为53%，单肺移植为41%）。
我们得出结论：（1）两种手术在肺气肿治疗中都是令人满意的选择，效果持久；（2）双侧肺移植不会增加手术死亡率或发病率，并且在肺量测定结果、氧合、运动耐量以及可能的晚期生存率方面有更优的改善；（3）双侧肺移植后功能（和晚期生存率）的更优改善可能归因于闭塞性细支气管炎发生后更多的肺储备。
