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中华胸部外科电子杂志 ›› 2024, Vol. 11 ›› Issue (03) : 193 -200. doi: 10.3877/cma.j.issn.2095-8773.2024.03.08

经验交流

自体肺移植术在胸部恶性肿瘤中的临床应用
李子健1, 王锐1, 钟云鹏1, 张迪轩1, 梁韵娟1, 杨超1, 何建行1, 李树本1,()   
  1. 1. 510120 广州,呼吸疾病全国重点实验室/国家呼吸系统疾病临床医学研究中心/国家呼吸医学中心,广州呼吸健康研究院,广州医科大学附属第一医院胸外科,广州医科大学
  • 收稿日期:2024-06-11 修回日期:2024-08-02 接受日期:2024-08-08 出版日期:2024-08-28
  • 通信作者: 李树本
  • 基金资助:
    国家重点研发计划(2021YFC2500905)

Clinical application of lung autotransplantation in thoracic malignancies

Zijian Li1, Rui Wang1, Yunpeng Zhong1, Dixuan Zhang1, Yunjuan Liang1, Chao Yang1, Jianxing He1, Shuben Li1,()   

  1. 1. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Thoracic Surgery, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
  • Received:2024-06-11 Revised:2024-08-02 Accepted:2024-08-08 Published:2024-08-28
  • Corresponding author: Shuben Li
  • About author:

    *Co-first authors.

引用本文:

李子健, 王锐, 钟云鹏, 张迪轩, 梁韵娟, 杨超, 何建行, 李树本. 自体肺移植术在胸部恶性肿瘤中的临床应用[J]. 中华胸部外科电子杂志, 2024, 11(03): 193-200.

Zijian Li, Rui Wang, Yunpeng Zhong, Dixuan Zhang, Yunjuan Liang, Chao Yang, Jianxing He, Shuben Li. Clinical application of lung autotransplantation in thoracic malignancies[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(03): 193-200.

目的

自体肺移植术为胸部恶性肿瘤避免全肺切除的替代术式之一,其应用范围包括局部晚期中央型肺癌、肺动脉肉瘤等。现总结单中心应用自体肺移植术治疗胸部恶性肿瘤的经验。

方法

纳入2019年7月至2024年3月于广州医科大学附属第一医院接受自体肺移植术的5例胸部恶性肿瘤患者,其中男3例,女2例。回顾手术入路、重建方式、围手术期情况(手术时间、术中出血量、术后呼吸支持时间、术后重症监护时间、术后引流管放置时间、术后住院时间)及随访结果。

结果

全组5例均顺利完成胸部恶性肿瘤的根治性切除,其中自体移植右肺下叶1例,左肺下叶基底段1例,右肺下叶基底段3例。1例行体内自体肺移植术,4例接受体外灌注自体肺移植术。手术时间为460(45)min,术后呼吸机辅助通气时间为4(2)天,术后ICU住院时间为4(2)天,术后住院时间为11(5)天。全组围手术期无死亡,无肺动脉栓塞、无吻合口瘘等重度并发症。全组术后密切随访2.9~59.9个月,1例术后40周病理确诊右侧气管旁淋巴结转移,其余4例均未见复发或转移。全组无复发生存期为13.9(47.9)个月。

结论

自体肺移植术在局部晚期中央型非小细胞肺癌、肺动脉肉瘤等胸部恶性肿瘤的临床应用安全、可行,值得推广。

Objective

The lung autotransplantation technique is one of the alternatives to pneumonectomy for thoracic malignancies, including locally advanced central lung cancer and pulmonary artery sarcoma. This study summarizes the experience and application of lung autotransplantation techniques in treating thoracic malignancies at our center.

Methods

Five patients (3 males and 2 females) of thoracic malignancies who underwent lung autotransplantation at the First Affiliated Hospital of Guangzhou Medical University between July 2019 and March 2024 were enrolled. Surgical approaches, reconstruction methods, perioperative conditions (operating time, intraoperative blood loss, postoperative respiratory support duration, postoperative ICU stay, postoperative drainage tube placement duration, postoperative hospital stay) , and follow-up results were retrospectively reviewed.

Results

All five cases successfully received radical resection of thoracic malignancies, including one case of lung autotransplantation of the right lower lobe, one case of the left lower lobe basal segment, and three cases of the right lower lobe basal segment. In situ lung autotransplantation was performed in one case, while the remaining four cases underwent the procedure through ex situ method. The operating time was 460 (45) minutes, the postoperative respiratory support duration was 4 (2) days, the postoperative ICU stay was 4 (2) days, and the postoperative hospital stay was 11 (5) days. There were no perioperative deaths and severe complications including pulmonary embolism and anastomotic leakage. Follow-up revealed one case of pathological right tracheal lymph node metastasis at 40 weeks postoperatively; the other four patients showed no recurrence or metastasis. The overall recurrence-free survival was 13.9 (47.9) months.

Conclusions

Lung autotransplantation is a safe and feasible approach for clinical application of locally advanced central non-small cell lung cancer, pulmonary artery sarcoma, and other thoracic malignancies, which is worthy of further promotion.

图1 下肺静脉与上肺静脉残端吻合
表1 患者围手术期资料
图2 5例患者术前(A)及术后(B)胸部CT对比图
表2 患者临床资料及术前评估资料
表3 患者术后住院情况
表4 患者术后治疗及随访情况
1
Sung HFerlay JSiegel RL,et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J].CA Cancer J Clin202171(3):209-249.
2
Chen ZFillmore CMHammerman PS,et al.Non-small-cell lung cancers: a heterogeneous set of diseases[J].Nat Rev Cancer201414(8):535-546.
3
Goldstraw PChansky KCrowley J,et al.The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer[J].J Thorac Oncol201611(1):39-51.
4
Graham EASinger JJ.Successful removal of an entire lung for carcinoma of the bronchus[J].CA Cancer J Clin197424(4):238-242.
5
THOMAS CP.Conservative resection of the bronchial tree[J].J R Coll Surg Edinb19561(3):169-186.
6
Berthet JPParadela MJimenez MJ,et al.Extended sleeve lobectomy: one more step toward avoiding pneumonectomy in centrally located lung cancer[J].Ann Thorac Surg201396(6):1988-1997.
7
Park JSYang HCKim HK,et al.Sleeve lobectomy as an alternative procedure to pneumonectomy for non-small cell lung cancer[J].J Thorac Oncol20105(4):517-520.
8
Costantino CLGeller ADWright CD,et al.Carinal surgery: A single-institution experience spanning 2 decades[J].J Thorac Cardiovasc Surg2019157(5):2073-2083.e1.
9
Di Rienzo GGo TMacchiarini P.Simplified anastomotic technique for end-to-side bronchial reimplantation onto the trachea or contralateral main bronchus after complex tracheobronchial resections[J].J Thorac Cardiovasc Surg2002124(3):632-635.
10
Green AHauge JIachina M,et al.The mortality after surgery in primary lung cancer: results from the Danish Lung Cancer Registry[J].Eur J Cardiothorac Surg201649(2):589-594.
11
Jakobsen EPalshof TOsterlind K,et al.Data from a national lung cancer registry contributes to improve outcome and quality of surgery: Danish results[J].Eur J Cardiothorac Surg200935(2):348-352.
12
Morgant MCPagès PBOrsini B,et al.Time trends in surgery for lung cancer in France from 2005 to 2012: a nationwide study[J].Eur Respir J201546(4):1131-1139.
13
Powell HATata LJBaldwin DR,et al.Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit[J].Thorax201368(9):826-834.
14
Riaz SPLinklater KMPage R,et al.Recent trends in resection rates among non-small cell lung cancer patients in England[J].Thorax201267(9):811-814.
15
Seder CWRaymond DPWright CD,et al.The Society of Thoracic Surgeons General Thoracic Surgery Database 2017 Update on Outcomes and Quality[J].Ann Thorac Surg2017103(5):1378-1383.
16
Thomas PABerbis JBaste JM,et al.Pneumonectomy for lung cancer: contemporary national early morbidity and mortality outcomes[J].J Thorac Cardiovasc Surg2015149(1):73-82.
17
Galetta DBorri AGasparri R,et al.Surgical Techniques and Long-Term Results of Pulmonary Artery Reconstruction in Patients With Lung Cancer[J].Ann Thorac Surg2015100(4):1196-1202.
18
Inci IBenker MÇitak N,et al.Complex sleeve lobectomy has the same surgical outcome when compared with conventional lobectomy in patients with lung cancer[J].Eur J Cardiothorac Surg202057(5):860-866.
19
Ma QLiu DGuo Y,et al.Surgical techniques and results of the pulmonary artery reconstruction for patients with central non-small cell lung cancer[J].J Cardiothorac Surg20138:219.
20
Okada MTsubota NYoshimura M,et al.Extended sleeve lobectomy for lung cancer: the avoidance of pneumonectomy[J].J Thorac Cardiovasc Surg1999118(4):710-713.
21
Pagès PBMordant PRenaud S,et al.Sleeve lobectomy may provide better outcomes than pneumonectomy for non-small cell lung cancer. A decade in a nationwide study[J].J Thorac Cardiovasc Surg2017153(1):184-195.e3.
22
Ricci CRendina EAVenuta F,et al.Reconstruction of the pulmonary artery in patients with lung cancer[J].Ann Thorac Surg199457(3):627-632.
23
Tedder MAnstadt MPTedder SD,et al.Current morbidity, mortality, and survival after bronchoplastic procedures for malignancy[J].Ann Thorac Surg199254(2):387-391.
24
Jiang FXu LYuan FL,et al.Lung autotransplantation technique in the treatment for central lung cancer of upper lobe[J].J Thorac Oncol20083(6):609-611.
25
Watanabe YSato MNakamura Y,et al.Right lower lobe autotransplantation for locally advanced central lung cancer[J].Ann Thorac Surg201599(1):323-326.
26
He JYang CSuen HC,et al.A novel lung autotransplantation technique for treating central lung cancer: a case report[J].Transl Lung Cancer Res202110(5):2290-2297.
27
Levvey BKeshavjee SCypel M,et al.Influence of lung donor agonal and warm ischemic times on early mortality: Analyses from the ISHLT DCD Lung Transplant Registry[J].J Heart Lung Transplant201938(1):26-34.
28
Nakajima DOhsumi AHamaji M,et al.Expanded indications for auto-lung transplant technique[J].Gen Thorac Cardiovasc Surg202068(8):828-832.
29
Yamamoto KMiyamoto YOhsumi A,et al.Surgical results of carinal reconstruction: an alterative technique for tumors involving the tracheal carina[J].Ann Thorac Surg200784(1):216-220.
30
Wang CDong JZhuang X,et al.Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series[J].Transl Lung Cancer Res202211(6):1145-1153.
31
Hamaji MChen-Yoshikawa TFDate H.Completion pneumonectomy and auto-transplantation for bronchopleural fistula[J].J Thorac Cardiovasc Surg2019158(3):e121-e123.
32
Zhang GLiu JJiang G,et al.Lung autotransplantation technique for treating central lung cancer of upper lobe[J].Zhonghua Wai Ke Za Zhi200038(4):245-249.
33
Shiono HOhta MHirabayashi H,et al.Transposition of the lower pulmonary vein for further mobilization in carinal reconstruction after induction therapy for lung cancer[J].J Thorac Cardiovasc Surg2004127(2):586-587.
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