摘要:
Objective To compare outcomes after single and bilateral lung transplantation in patients with idiopathic pulmonary fibrosis (IPF).Methods 104 patients with IPF who underwent lung transplantation at Wuxi People' s Hospital from January 2008 to February 2015 were evaluated.Recipients were divided into single lung transplantation (STL)group(41 cases)and bilateral lung transplantation(BLT) group (63 cases).Preoperative characteristics,postoperative outcomes,postoperative complications,functional outcomes,survival and causes of death between the two groups were analyzed retrospectively.The patients were followed up by letter,call and outpatient visit.Results Preoperative characteristics:The SLT group were significantly older (P < 0.05),and had significantly higher systolic (P < 0.05) pulmonary artery pressures than the BLT group.Postoperative outcomes:The intraoperative blood loss of SLT group as significantly less than BLT group (P < 0.05).The cold ischemic time of SLT group as significantly shorter than BLT group (P < 0.05).The BLT group was significantly more frequently required extracorporeal membrane oxygenation (ECMO) support than SLT group (P < 0.05).There was no statistically significant difference inventilator support,reoperation,reintubation,length of ICU stay and death between the SLT and the BLT group (P > 0.05).Postoperative complications:The BLT group had a higher incidence of primary graft dysfunction than the SLT group (P < 0.05).There was no statistically significant difference in chest complications,acute rejection,airway complications,pulmonary infection between the SLT and the BLT group (P>0.05).Functional outcomes:FVC%,FEV1%,DLCO and 6-MWD,were significantly higher in the BLT group than the SLT group (P <0.05).Survival:The overall survival rates at 1,2 and 3 years were not different between the SLT and the BLT group (75.3%,61.6% and 46.2% vs 79.1%,68.6% and 53.4%,P > 0.05).Conclusions The lung transplantationis an effective treatment for idiopathic pulmonary fibrosis,BLT could significantly improve the postoperative lung functionin comparison with STL,BLT may be a preferable operation for younger patients,especially if significant pulmonary hypertension is present.The short-term survival of BLT was similar to SLT,but long-term survivalstill needs further followup.Considering the quality of life,BLT is better than SLT.%目的 应用回顾性队列研究的方法比较单肺移植与双肺移植治疗特发性肺间质纤维化(IPF)的临床效果,为术式选择提供参考.方法 回顾分析2008年1月至2015年2月无锡市人民医院胸外科通过肺移植手术治疗IPF的病例资料,共104例,其中男76例,女28例,年龄46 ~ 69岁,平均(57.6±11.5)岁.根据手术类型分为单肺移植组(41例)与双肺移植组(63例),对两组患者的术前一般情况、围手术期情况、术后并发症、术后的肺功能改善及累积生存率等进行对比分析.结果 术前一般情况:年龄:单肺移植组41例,其中男33例,女8例,年龄55 ~ 69岁,平均年龄(61.7±7.0)岁.双肺移植组63例,其中男43例,女20例,年龄46 ~65岁,平均年龄(55.6±9.4)岁,单肺移植组年龄较双肺移植组高(P<0.05).肺动脉平均收缩压:单肺移植组[(34.3 ±13.1)mmHg,1 mmHg=0.133 kPa]较双肺移植组[(44.1±17.9) mmHg]低(P<0.05).术中出血量:单肺移植组[(973±382) ml]较双肺移植组[(1590±617)ml]少(P<0.05).冷缺血时间:单肺移植组较双肺移植组低短(P<0.05).术中ECMO使用率:双肺移植组较单肺移植组低高(P<0.05).两组患者在术后气管插管时间、再次开胸手术、再次气管插管、ICU住院时间以及围手术期病死率等方面差异无明显统计学意义(P>0.05).术后并发症:原发性移植物失功能发生率:双肺移植组(11例,发生率17.5%)较单肺移植组(5例,发生率12.2%)高(P<0.05).两组患者在肺部感染、胸腔并发症、急性排斥反应及气道并发症等方面差异无统计学意义(P>0.05).术后肺功能改善:双肺移植组FVC占预计值%、FEV1占预计值%、DLCO占预计值%、6 min步行试验距离均优于单肺移植组(P<0.05).累积生存率:单肺移植组与双肺移植组术后l、2、3年累积生存率分别为75.3%、61.6%、46.2%及79.1%、68.6%、53.4%,差异无统计学意义(P>0.05).结论 肺移植是IPF的有效治疗方式,双肺移植对于术后肺功能的改善优于单肺移植,对于年轻特别是肺动脉压力较高的受者可首先选择行双肺移植术.单肺移植与双肺移植早中期生存率相似,但远期生存率仍需进一步随访研究.就IPF患者术后生存质量而言,双肺移植优于单肺移植.