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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/OL]. 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/OL]. 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
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