Waddell T K, Keshavjee S
The Division of Thoracic Surgery and Lung Transplant Program, The University of Toronto and The Toronto Hospital, Ontario, Canada.
Semin Thorac Cardiovasc Surg. 1998 Jul;10(3):191-201. doi: 10.1016/s1043-0679(98)70037-1.
Emphysema is the fifth leading cause of death in North America. It is now the most common indication for lung transplantation worldwide. Since 1986, evolution in operative techniques and improvements in organ preservation and post-operative immunosuppression have resulted in impressive long-term survival results. Significant problems remain in terms of inadequate organ supply and chronic rejection; many more candidates could be transplanted if not for these two major limitations. However, other options are now available for the surgical management of patients with end-stage emphysema. The decision making surrounding transplantation for emphysema has been radically altered by the advent of lung volume reduction surgery. This review will highlight new data that pertains to recipient and donor selection, choice of transplant procedure, either single or bilateral, and the role of lung volume reduction surgery. At the University of Toronto we generally favour bilateral lung transplantation for superior functional results and possibly enhanced long-term survival. We have been particularly interested in combining lung transplantation with synchronous lung volume reduction surgery and the rationale and results of this procedure are reviewed.
肺气肿是北美地区第五大死因。目前，它是全球范围内肺移植最常见的适应症。自1986年以来，手术技术的进步、器官保存的改善以及术后免疫抑制的进展带来了令人瞩目的长期生存结果。在器官供应不足和慢性排斥方面仍然存在重大问题；如果没有这两个主要限制因素，更多的候选者本可以接受移植。然而，对于终末期肺气肿患者的外科治疗，现在有了其他选择。肺减容手术的出现从根本上改变了围绕肺气肿移植的决策。本综述将重点介绍与受者和供者选择、移植手术方式（单肺或双肺）的选择以及肺减容手术的作用相关的新数据。在多伦多大学，我们通常倾向于进行双肺移植，以获得更好的功能结果并可能提高长期生存率。我们一直对将肺移植与同期肺减容手术相结合特别感兴趣，并对该手术的原理和结果进行了综述。
