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65岁以上终末期肺病患者肺移植疗效及预后分析

夏维 严洁 毛文君 陈静瑜

夏维, 严洁, 毛文君, 等. 65岁以上终末期肺病患者肺移植疗效及预后分析[J]. 器官移植, 2015, 6(6): 382-387. doi: 10.3969/j.issn.1674-7445.2015.06.007
引用本文: 夏维, 严洁, 毛文君, 等. 65岁以上终末期肺病患者肺移植疗效及预后分析[J]. 器官移植, 2015, 6(6): 382-387. doi: 10.3969/j.issn.1674-7445.2015.06.007
Xia Wei, Yan Jie, Mao Wenjun, et al. Curative effect and prognosis analysis of lung transplantation for patients over 65 years old with end-stage lung diseases[J]. ORGAN TRANSPLANTATION, 2015, 6(6): 382-387. doi: 10.3969/j.issn.1674-7445.2015.06.007
Citation: Xia Wei, Yan Jie, Mao Wenjun, et al. Curative effect and prognosis analysis of lung transplantation for patients over 65 years old with end-stage lung diseases[J]. ORGAN TRANSPLANTATION, 2015, 6(6): 382-387. doi: 10.3969/j.issn.1674-7445.2015.06.007

65岁以上终末期肺病患者肺移植疗效及预后分析

doi: 10.3969/j.issn.1674-7445.2015.06.007
基金项目: 

国家十一五科技支撑计划 2008BAI160B05

详细信息
    通讯作者:

    毛文君, Email:maowenjun1@126.com

  • 中图分类号: R617

Curative effect and prognosis analysis of lung transplantation for patients over 65 years old with end-stage lung diseases

More Information
  • 摘要:   目的  探讨65岁以上终末期肺病患者肺移植的疗效及预后。  方法  回顾性分析2002年9月至2011年12月南京医科大学附属无锡市人民医院收治的24例老年(≥65岁)肺移植病例的临床资料。了解老年肺移植患者的存活情况, 比较单肺和双肺移植的存活情况; 了解肺移植术后并发症及对随访期内死亡的病例进行死因分析。  结果  所有患者肺移植手术均顺利完成。24例受者术后1、3、5、7年累积存活率分别为75.0%、62.5%、33.3%和12.5%, 其中单肺移植患者相应为68.8%、50.0%、31.3%和12.5%, 双肺移植患者相应为87.5%、87.5%、37.5%和12.5%。单肺与双肺移植患者中位生存时间分别为35、51个月, 两组生存期比较差异无统计学意义(P>0.05)。感染是术后最主要的并发症, 发生率为46%(11/24)。术后长期随访中17例死亡, 包括重症感染9例, 原发性移植物失功(PGD)1例, 急性排斥反应(AR)1例, 闭塞性细支气管炎(BOS)4例, 心力衰竭1例, 肿瘤1例。  结论  单肺或双肺移植均是治疗老年终末期肺病的有效方法, 感染是老年受者术后最主要的并发症和死亡原因。

     

  • 图  1  单肺与双肺移植受者生存曲线

    Figure  1.  Survival curves of patients with unilateral and bilateral lung transplantation

    图  2  肺移植术后合并吻合口真菌感染患者的纤维支气管镜下表现

    注:A图示纤支镜下见吻合口真菌感染;B图示经治疗后复查纤支管镜下见吻合口真菌感染明显好转

    Figure  2.  Fungal infection in the anastomotic stoma of a patient after lung transplantation under the bronchoscope

    表  1  单肺移植与双肺移植老年患者的术前临床资料比较

    Table  1.   Comparison of preoperative clinical data of elderly patients receiving unilateral or bilateral lung transplantation

    项目 单肺移植
    (n=16)
    双肺移植
    (n=8)
    P
    年龄[岁,(x±s)] 69.5±3.3 65.3±3.9 0.319
    性别[男/女,n/n] 10/6 4/4 0.439
    体重指数(kg/m2) 20.9±3.3 21.8±2.5 0.192
    诊断(n)
    IPF 10 6 0.57
    COPD 4 2
    其他 2 0
    呼吸机依赖(n) 10 2 0.097
    MPAP≥30 mmHg(n) 12 6 0.698
    NYHA心功能分级(n)
    Ⅰ~Ⅱ级 0 0 0.221
    Ⅲ级 4 4
    Ⅳ级 12 4
    使用ECMO(n) 4 6 0.028
    ICU停留时间[d,(x±s)] 6.4±3.7 8.2±2.5 0.071
    住院时间[d,(x±s)] 52±7 65±9 0.124
    有并发症(n) 10 3 0.235
    注:ECMO为体外膜肺氧合
    下载: 导出CSV

    表  2  单肺与双肺移植患者术后并发症比较

    Table  2.   Comparison of postoperative complications of patients between unilateral lung transplantation and bilateral lung transplantation

    术后并发症 单肺移植
    (n=16)
    双肺移植
    (n=8)
    P
    重症感染 7 4 0.556
    PGD 2 1 0.723
    AR 1 0 0.667
    BOS 5 3 0.553
    出血 1 0 0.667
    吻合口并发症 1 0 0.667
    糖尿病 3 2 0.555
    其他 3 2 0.555
    下载: 导出CSV
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出版历程
  • 收稿日期:  2015-08-20
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2015-11-15

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