肺移植术后早期严重的消化系统并发症。

Early severe digestive complications after lung transplantation.

机构信息

Service de Chirurgie Thoracique, Vasculaire, et de Transplantation Pulmonaire, Hôpital Bichat, AP-HP, Université Denis Diderot - Paris 7, Paris, France.

出版信息

Eur J Cardiothorac Surg. 2011 Dec;40(6):1419-24. doi: 10.1016/j.ejcts.2011.02.069. Epub 2011 Apr 15.

DOI:10.1016/j.ejcts.2011.02.069

PMID:21497510

Abstract

OBJECTIVE

This study aimed to describe and to analyze early severe digestive complications (ESDC) after lung transplantation (LT) in our center.

METHODS

A retrospective study included 351 patients, who underwent LT without cardiopulmonary bypass (CPB) at our center between March 1988 and December 2009. There were 86 double LTs and 265 single LTs. ESDCs were defined as complications (1) occurring during the first 30 days after transplantation or during initial hospitalization if longer; (2) involving the gastrointestinal tract; and (3) jeopardizing survival or requiring invasive therapeutic procedure. Patients' characteristics, associated risk factors, and influence of ESDC on early outcome have been analyzed.

RESULTS

During the first 30 days after LT or initial hospitalization if longer, 26 ESDCs occurred in 26 patients (rate 7.4%, sex ratio M/F 66%, mean age 56 ± 6 years). This included 10 acute cholecystitis (38%), four angiocholitis (15%), three perforated gastroduodenal ulcers (11%), three digestive perforations (11%), two intestinal occlusions (8%), two mesenteric ischemia (8%), and two acute pancreatitis (8%). ESDC occurred after a mean postoperative follow-up of 14 days (5-46), required emergency surgical treatment in 20 cases (77%), significantly prolonged the mean duration of hospitalization (96 days with ESDC vs 55 days without ESDC, p < 0.0001), and was responsible for death in five cases (19%). Surgical treatment included cholecystectomy (n = 11), bowel resection (n = 3), ulcer surgery (n = 2), subtotal colectomy (n = 2), Hartmann procedure (n = 1), and open coelioscopy (n = 1). Age and bilateral LT were found to be significant risk factors for ESDC in both uni- and multivariate analyses.

CONCLUSION

ESDC occurred in 7.4% of patients after LT without CPB, and was responsible for longer in-hospital stay. Relevant risk factors included older age and bilateral LT, interfering with current debate regarding recipients' selection and procedure's choice.

摘要

目的

本研究旨在描述和分析我中心肺移植（LT）后早期严重的消化道并发症（ESDC）。

方法

本回顾性研究纳入了 1988 年 3 月至 2009 年 12 月期间在我中心行非体外循环（CPB）下 LT 的 351 例患者。其中包括 86 例双肺 LT 和 265 例单肺 LT。ESDC 定义为：（1）发生在移植后 30 天内或初始住院期间（如果更长）；（2）涉及胃肠道；（3）危及生存或需要侵入性治疗。分析了患者的特征、相关危险因素以及 ESDC 对早期结果的影响。

结果

在 LT 后 30 天内或初始住院期间（如果更长），26 例患者发生 26 例 ESDC（发生率 7.4%，男女比例 66%，平均年龄 56 ± 6 岁）。这包括 10 例急性胆囊炎（38%）、4 例胆管炎（15%）、3 例穿孔性胃十二指肠溃疡（11%）、3 例消化道穿孔（11%）、2 例肠阻塞（8%）、2 例肠系膜缺血（8%）和 2 例急性胰腺炎（8%）。ESDC 发生在术后平均随访 14 天（5-46 天）后，20 例患者需要紧急手术治疗（77%），显著延长了平均住院时间（ESDC 患者为 96 天，无 ESDC 患者为 55 天，p<0.0001），并导致 5 例患者死亡（19%）。手术治疗包括胆囊切除术（n=11）、肠切除术（n=3）、溃疡手术（n=2）、次全结肠切除术（n=2）、Hartmann 手术（n=1）和剖腹探查术（n=1）。单变量和多变量分析均发现年龄和双侧 LT 是 ESDC 的显著危险因素。