合并肺段挫伤供肺肺移植的临床疗效分析

叶书高; 李慧星; 刘峰; 刘东; 陈静瑜

doi:10.3969/j.issn.1674-7445.2018.01.008

合并肺段挫伤供肺肺移植的临床疗效分析

doi: 10.3969/j.issn.1674-7445.2018.01.008

214023 江苏无锡，南京医科大学附属无锡市人民医院江苏省器官移植重点实验室

基金项目:

江苏省第四期“333工程”科研项目 BRA2013026

详细信息

作者简介:
叶书高，男，1972年生，研究生学历，副主任医师，研究方向为肺移植，Email: ysg206@hotmail.com

通讯作者:
陈静瑜，男，1963年生，研究生学历，主任医师，研究方向为肺移植，Email: chenjy@wuxiph.com

中图分类号: R617, R563
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出版历程
- 收稿日期: 2017-10-20
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-01-15

Clinical analysis of lung transplantation from donors combined with pulmonary contusion

Jiangsu Provincial Key Laboratory of Organ Transplantation, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China

More Information

Corresponding author: Chen Jingyu, E-mail:chenjy@wuxiph.com

摘要

摘要: 目的探讨合并肺段挫伤供肺肺移植治疗终末期肺病的疗效及预后。方法收集73例供、受体的临床资料，根据供肺是否合并挫伤，将供、受体分为挫伤组（各23例，挫伤最大直径5~8 cm）和标准组（各50例）。比较两组受体术后主要临床指标[包括术毕氧合指数、机械通气时间、胸管留置时间、原发性移植物失功（PGD）发生率等]及预后情况。结果两组受体的术毕氧合指数、机械通气时间、胸管留置时间、PGD发生率比较，差异均无统计学意义（均为P>0.05）。标准组和挫伤组受体术后1年存活率分别为74%和83%，两组比较差异无统计学意义（P>0.05）。结论合并肺段肺挫伤（最大直径5~8 cm）的供肺肺移植疗效和预后接近标准供肺移植。
- 肺挫伤 /
- 肺移植 /
- 终末期肺病 /
- 慢性阻塞性肺疾病(COPD) /
- 原发性移植物失功(PGD) /
- 氧合指数 /
- 机械通气 /
- 离体修复 /
- 体外膜肺氧合（ECMO）
Abstract: Objective To explore the efficacy and prognosis of lung transplantation from donors combined with pulmonary contusion on the treatment of patients with end-stage lung disease. Methods Clinical data of 73 cases of donors and recipients were collected. The donors and recipients were divided into contusion group (23 cases of donors and recipients, with a maximum diameter of contusion in 5-8 cm) and standard group (50 cases of donors and recipients) depending on combined pulmonary contusion. Major clinical indicators [postoperative oxygenation index, duration of mechanical ventilation and chest tube drainage and incidence of primary graft dysfunction (PGD)] and prognosis of the recipients in both groups were compared. Results The recipients in both groups presented no significant difference in postoperative oxygenation index, duration of mechanical ventilation and chest tube drainage and incidence of PGD (all P>0.05). The postoperative 1-year survival of the recipients in standard group and contusion group was 74% and 83%, which presented no statistically significant difference (P>0.05). Conclusions The efficacy and prognosis of lung transplantation from donors combined with pulmonary contusion (with a maximum diameter of 5-8 cm) are comparable to those of lung transplantation from standard donors.
- Pulmonary contusion /
- Lung transplantation /
- End-stage lung disease /
- Chronic obstructive pulmonary disease (COPD) /
- Primary graft dysfunction (PGD) /
- Oxygenation index /
- Mechanical ventilation /
- Vitro repair /
- Extracorporeal membrane oxygenation (ECMO)

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图 1 两组受体肺移植术后的累积存活率

Figure 1. Cumulative survival rate of recipients after lung transplantation between two groups

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表 1 两组受体术后临床指标的比较

Table 1. Comparison of clinical indexes after operation of recipients between two groups

组别	n	术毕氧合指数（x±s，mmHg）		机械通气时间 [M(Q)，h]	胸管留置时间（x±s，h）	PGD [n（%）]
组别	n	单侧	双侧	机械通气时间 [M(Q)，h]	胸管留置时间（x±s，h）	PGD [n（%）]
标准组	50	348±140	315±139	22（16~38）	17±6	10（20）
挫伤组	23	332±167	384±119	20（16~29）	18±4	2（9）
统计值		0.233	-1.750	719.5	-0.059	1.466
P值		0.818	-0.086	0.118	-0.557	0.317
10 mmHg=1.33 kPa

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参考文献(19)

[1]	陈静瑜, 朱艳红. 肺移植国内外研究新进展[J/CD]. 中华移植杂志(电子版), 2009, 3(2): 136-140. DOI: 10.3969/j.issn.1674-3903.2009.02.011. CHEN JY, ZHU YH. New progress in lung transplantation in domestic and abroad[J/CD]. Chin J Organ Transplant(Electr Vers), 2009, 3(2): 136-140. DOI: 10.3969/j.issn.1674-3903.2009.02.011.
[2]	陈静瑜.肺移植供体肺的维护及获取[J].武汉大学学报(医学版), 2016, 37(4): 540-542. DOI: 10.14188/j.1671-8852.2016.04.006. CHEN JY. Maintenance and acquisition of donor lung in lung transplantation[J]. Med J Wuhan Univ, 2016, 37(4): 540-542. DOI: 10.14188/j.1671-8852.2016.04.006.
[3]	卫生部医管司. 中国心脏死亡器官捐献分类标准[EB/OL]. [2017-08-01]. http://www.gov.cn/gzdt/2011-05/03/content_1856816.htm.
[4]	陈静瑜.胸部微创技术在肺移植切口中的应用[J].中国微创外科杂志, 2006, 6(9): 648-649. DOI: 10.3969/j.issn.1009-6604.2006.09.003. CHEN JY. Application of minimally invasive technique of chest in the incision of lung transplantation[J]. Chin J Min Inv Surg, 2006, 6(9): 648-649. DOI: 10.3969/j.issn.1009-6604.2006.09.003.
[5]	周敏, 朱艳红, 严洁, 等.肺移植术后原发性移植物功能丧失的预防和治疗[J].中华器官移植杂志, 2012, 33(8): 495-497. DOI: 10.3760/cma.j.issn.0254-1785.2012.08.014. ZHOU M, ZHU YH, YAN J, et al. Prevention and treatment of primary graft dysfunction after lung transplantation (108 cases report)[J]. Chin J Organ Tranplant, 2012, 33(8): 495-497. DOI: 10.3760/cma.j.issn.0254-1785.2012.08.014.
[6]	吴波, 张稷, 卫栋, 等.器官捐赠供肺移植受者术后早期肺部感染17例临床分析[J].中华器官移植杂志, 2015, 36(5): 261-264. DOI: 10.3760/cma.j.issn.0254-1785.2015.05.002. WU B, ZHANG J, WEI D, et al. Early respiratory infections in lung transplantation recipients from donation after cardiac death donors[J]. Chin J Organ Transplant, 2015, 36(5): 261-264. DOI: 10.3760/cma.j.issn.0254-1785.2015.05.002.
[7]	黄清华.我国人体器官捐赠移植立法问题研究[J].法律与医学杂志, 2000, 7(4): 166-170. DOI: 10.3969/j.issn.1674-1226.2000.04.011. HUANG QH. The legislation on human organ donation and transplantation in China[J]. J Law Med, 2000, 7(4): 166-170. DOI: 10.3969/j.issn.1674-1226.2000.04.011.
[8]	王镪, 黄晓波, 邓小凡, 等.DBCD供体状态与器官移植受者术后器官功能恢复的相关性分析[J].器官移植, 2015, 6(2): 80-85. DOI: 10.3969/j.issn.1674-7445.2015.02.003. WANG Q, HUANG XB, DENG XF, et al. Correlation analysis between the status of DBCD donors and postoperative recovery of organ function in organ transplant recipients[J]. Organ Transplant, 2015, 6(2): 80-85. DOI: 10.3969/j.issn.1674-7445.2015.02.003.
[9]	WATTS RP, THON O, FRASER JF. Inflammatory signaling associated with brain dead organ donation: from brain injury to brain stem death and posttransplant ischaemia reperfusion injury[J]. J Transplant, 2013:521369. DOI: 10.1155/2013/521369.
[10]	SANCHEZ PG, ROUSE M, PRATT DL, et al. Lung donation after controlled circulatory determination of death: a review of current practices and outcomes[J]. Transplant Proc, 2015, 47(6): 1958-1965. DOI: 10.1016/j.transproceed.2015.06.026.
[11]	胡志平, 冷希圣, 黄磊, 等.心脏死亡供肝肝移植的疗效观察[J].中华普通外科杂志, 2016, 31(3): 221-223.DOI: 10.3760/cma.j.issn.1007-631X.2016.03.013. HU ZP, LENG XS, HUANG L, et al. Clinical outcomes of liver transplantation from graft donation of cardiac death donors[J]. Chin J Gen Surg, 2016, 31(3): 221-223. DOI: 10.3760/cma.j.issn.1007-631X.2016.03.013.
[12]	傅斌生, 易述红, 唐晖, 等.公民逝世后器官捐献供肝质量评估和维护的体会[J].器官移植, 2016, 7(3): 215-218. DOI: 10.3969/j.issn.1674-7445.2016.03.011. FU BS, YI SH, TANG H, et al. Experience of quality evaluation and function maintenance of donor liver from organ donation after citizen's death[J]. Organ Transplant, 2016, 7(3): 215-218. DOI: 10.3969/j.issn.1674-7445.2016.03.011.
[13]	葛慧青, 沈晔, 陈静瑜, 等.脑死亡器官捐赠供肺保护及通气管理2例报道[J].中华器官移植杂志, 2015, 36(5): 265-270. DOI: 10.3760/cma.j.issn.0254-1785. 2015.05.003. GE HQ, SHEN Y, CHEN JY, et al. Lung protective and ventilatory management strategies in potential lung donor patients after brain death: report of two cases[J]. Chin J Organ Transplant, 2015, 36(5): 265-270. DOI: 10.3760/cma.j.issn.0254-1785. 2015.05.003.
[14]	VAN RAEMODONCK D, NEYRINCK A, VERLEDEN GM, et al. Lung donor selection and management[J]. Proc Am Thorac Soc, 2009, 6(1): 28-38. DOI: 10.1513/pats.200808-098GO.
[15]	Zeriouh M, Sabashnikov A, Mohite PN, et al. Utilization of the organ care system for bilateral lung transplantation: preliminary results of a comparative study[J]. Interact Cardiovasc Thorac Surg, 2016, 23(3): 351-357. DOI: 10.1093/icvts/ivw135.
[16]	Hashimoto K, Cypel M, Kim H, et al. Soluble adhesion molecules during ex vivo lung perfusion are associated with posttransplant primary graft dysfunction[J]. Am J Transplant, 2017, 17(5): 1396-1404. DOI: 10.1111/ajt.14160.
[17]	LEE JC, CHRISTIE JD, KESHVJEE S. Primary graft dysfunction: definition, risk factors, short-and long-term outcomes[J]. Semin Respir Crit Care Med, 2010, 31(2): 161-171. DOI: 10.1055/s-0030-1249111.
[18]	WEYKER PD, WEBB CA, KIAMANESH D, et al. Lung ischemia reperfusion injury: a bench-to-bedside review[J]. Semin Cardiothorac Vasc Anesth, 2013, 17(1): 28-43. DOI: 10.1177/1089253212458329.
[19]	董建涛.肺挫伤的研究及诊治[J].医疗装备, 2017, 30(7): 199-200. DOI: 10.3969/j.issn.1002-2376.2017.07.132. DONG JT. Research and treatment of pulmonary contusion[J]. Chin J Med Dev, 2017, 30(7): 199-200. DOI: 10.3969/j.issn.1002-2376.2017.07.132.