Stefaniak Tomasz, Głowacki Janusz, Dymecki Dariusz, Lachinski Andrzej, Gruca Zbigniew
Department of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdansk, 1 Prof. Kieturakis Str., PL 80 742 Gdansk, Poland.
Surg Today. 2003;33(9):693-7. doi: 10.1007/s00595-002-2564-1.
Serious complications involving the alimentary tract following cardiac transplantations are commonly reported, and may be associated with significant morbidity and mortality. One of the most serious gastrointestinal complications in such patients is acute pancreatitis. There is still little known concerning its pathogenesis, early diagnosis, and the most appropriate treatment for this clinical condition. Many authors have reported a high mortality caused by difficulties in making an accurate diagnosis resulting in the use of inappropriate therapy for so called crypto-symptomatic acute pancreatitis. The factor suspected to be responsible for the increased frequency of the gastroenterological diseases and for their masked onset seems to be immunosuppression, especially by corticosteroids. The case of a 46-year-old male patient with cardiac transplant, who, 3 years after the transplantation, developed mild acute pancreatitis, is presented. The immunosuppressive regimen he followed was based on cyclosporine. The acute pancreatitis was treated conservatively with a satisfactory outcome. In the course of the illness the patient developed a pancreatic pseudocyst that was managed successfully by percutaneous drainage. The patient is currently being followed up, and both his medical ailments and health-related quality of life are being monitored, while he continues to show mild symptoms of chronic pancreatitis.
心脏移植后累及消化道的严重并发症屡有报道，且可能伴有显著的发病率和死亡率。此类患者最严重的胃肠道并发症之一是急性胰腺炎。关于其发病机制、早期诊断以及针对该临床病症的最恰当治疗方法，目前仍知之甚少。许多作者报告称，由于难以准确诊断，导致对所谓隐匿症状性急性胰腺炎采用不恰当的治疗方法，从而造成了较高的死亡率。疑似导致胃肠疾病发病率增加及其隐匿起病的因素似乎是免疫抑制，尤其是皮质类固醇引起的免疫抑制。本文介绍了一名46岁男性心脏移植患者的病例，该患者在移植后3年发生了轻度急性胰腺炎。他所遵循的免疫抑制方案以环孢素为基础。急性胰腺炎采用保守治疗，效果令人满意。在患病过程中，患者出现了胰腺假性囊肿，通过经皮引流成功处理。目前该患者正在接受随访，其疾病状况和与健康相关的生活质量均受到监测，同时他仍表现出慢性胰腺炎的轻微症状。
