Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation
Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation
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DOI：
10.1067/mtc.2003.166
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发表时间：
2003-03-01
影响因子：
6
通讯作者：
Palmer, SM
中科院分区：
文献类型：
--
作者：
Davis, RD;Lau, CL;Palmer, SM
目的：闭塞性细支气管炎是肺移植长期适用性的最大限制。虽然同种免疫事件是重要的，非免疫事件，如胃食管反流，可能有助于肺损伤和闭塞性细支气管炎综合征的发展。方法：对1992年4月至2002年4月在杜克大学肺移植项目接受肺移植的396例患者进行回顾性研究。使用动态24小时食管pH探头评估反流。结果：对128例肺移植术后患者进行了食管pH探头反流评估。93例（73%）患者出现pH值异常。43例患者接受了手术治疗。手术患者无住院死亡率和30天死亡率。扩底时，26例患者符合闭塞性细支气管炎综合征标准。经复底治疗后，16例患者闭塞性细支气管炎综合征评分改善，其中13例患者不再符合闭塞性细支气管炎综合征的标准。肺移植术后至少6个月及底扩术后6个月患者，1秒用力呼气量平均提高24%(底扩术前1秒平均用力呼气量1.87 L；底扩术后1秒平均用力呼气量2.19 Usec
Objectives: Bronchiolitis obliterans is the greatest limitation to the long-term applicability of lung transplantation. Although alloimmune events are important, nonimmune events, such as gastroesophageal reflux, might contribute to lung injury and the development of bronchiolitis obliterans syndrome.Methods: We retrospectively studied the 396 patients who underwent lung transplantation at the Duke Lung Transplant Program from April 1992 to April 2002. Reflux was assessed for using an ambulatory 24-hour esophageal pH probe.Results: Reflux assessment with an esophageal pH probe was obtained in 128 patients after lung transplantation. Abnormal pH study results were present in 93 (73%) patients. Forty-three patients underwent a surgical fundoplication. There was no in-hospital or 30-day mortality in the patients undergoing fundoplication. At the time of fundoplication, 26 patients met the criteria for bronchiolitis obliterans syndrome. After fundoplication, 16 patients had improved bronchiolitis obliterans syndrome scores, with 13 of these patients no longer meeting the criteria for bronchiolitis obliterans syndrome. In patients at least 6 months after lung transplantation and 6 months after fundoplication, the forced expiratory volume in I second improved by an average of 24% (mean forced expiratory volume in I second before fundoplication, 1.87 L; mean forced expiratory volume in 1 second after fundoplication, 2.19 Usec; P