Kirklin J K, Holm A, Aldrete J S, White C, Bourge R C
University of Alabama, Department of Surgery, Birmingham 35294.
Ann Surg. 1990 May;211(5):538-41; discussion 541-2. doi: 10.1097/00000658-199005000-00003.
Acute gastrointestinal (GI) illnesses are unusual but potentially fatal complications following cardiac transplantation. A retrospective study was performed to analyze the frequency, etiology, and severity of GI complications and the potential impact of early diagnosis and prompt surgical intervention when appropriate. Between 1981 and July 1, 1988, 31 GI complications (pancreatic, 6; colonic, 6; gastroduodenal, 6; biliary, 5; esophageal, 3; appendiceal, 2; hernia, 2; and splenic, 1) occurred in 26 patients undergoing 32 cardiac transplants. Complications were most common (14 of 31 patients, 45%) within the first 30 days after transplantation. Seventeen GI complications were treated medically (2 deaths), 2 with elective surgery and 12 with emergent operations (3 deaths). The overall mortality rate was 16%. All patients who underwent emergent operations within 3 days of onset of symptoms survived; the mean interval of onset between symptoms and operation in the nonsurvivors was 10 +/- 3.8 days. We infer that among patients requiring urgent surgical intervention, successful outcome is enhanced by intense surveillance for early symptoms, prompt diagnostic evaluation, and early surgical intervention.
急性胃肠道（GI）疾病是心脏移植术后不常见但可能致命的并发症。进行了一项回顾性研究，以分析胃肠道并发症的发生率、病因和严重程度，以及早期诊断和在适当情况下及时进行手术干预的潜在影响。在1981年至1988年7月1日期间，32例接受心脏移植的26例患者发生了31例胃肠道并发症（胰腺，6例；结肠，6例；胃十二指肠，6例；胆道，5例；食管，3例；阑尾，2例；疝，2例；脾脏，1例）。并发症在移植后的前30天内最为常见（31例患者中的14例，45%）。17例胃肠道并发症接受了内科治疗（2例死亡），2例接受了择期手术，12例接受了急诊手术（3例死亡）。总死亡率为16%。所有在症状出现后3天内接受急诊手术的患者均存活；非存活者症状出现与手术之间的平均间隔为10±3.8天。我们推断，在需要紧急手术干预的患者中，通过对早期症状进行密切监测、及时进行诊断评估和早期手术干预可提高成功预后的几率。
