肺移植术后腹部并发症的发生率及危险因素
Incidence and Risk Factors of Abdominal Complications After Lung Transplantation.
作者信息
Grass Fabian, Schäfer Markus, Cristaudi Alessandra, Berutto Carine, Aubert John-David, Gonzalez Michel, Demartines Nicolas, Ris Hans-Beat, Soccal Paola M, Krueger Thorsten
机构信息
Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, 1011, Lausanne, Switzerland,
出版信息
World J Surg. 2015 Sep;39(9):2274-81. doi: 10.1007/s00268-015-3098-1.
BACKGROUND
Due to the underlying diseases and the need for immunosuppression, patients after lung transplantation are particularly at risk for gastrointestinal (GI) complications that may negatively influence long-term outcome. The present study assessed the incidences and impact of GI complications after lung transplantation and aimed to identify risk factors.
METHODS
Retrospective analysis of all 227 consecutively performed single- and double-lung transplantations at the University hospitals of Lausanne and Geneva was performed between January 1993 and December 2010. Logistic regressions were used to test the effect of potentially influencing variables on the binary outcomes overall, severe, and surgery-requiring complications, followed by a multiple logistic regression model.
RESULTS
Final analysis included 205 patients for the purpose of the present study, and 22 patients were excluded due to re-transplantation, multiorgan transplantation, or incomplete datasets. GI complications were observed in 127 patients (62%). Gastro-esophageal reflux disease was the most commonly observed complication (22.9%), followed by inflammatory or infectious colitis (20.5%) and gastroparesis (10.7%). Major GI complications (Dindo/Clavien III-V) were observed in 83 (40.5%) patients and were fatal in 4 patients (2.0%). Multivariate analysis identified double-lung transplantation (p = 0.012) and early (1993-1998) transplantation period (p = 0.008) as independent risk factors for developing major GI complications. Forty-three (21%) patients required surgery such as colectomy, cholecystectomy, and fundoplication in 6.8, 6.3, and 3.9% of the patients, respectively. Multivariate analysis identified Charlson comorbidity index of ≥3 as an independent risk factor for developing GI complications requiring surgery (p = 0.015).
CONCLUSION
GI complications after lung transplantation are common. Outcome was rather encouraging in the setting of our transplant center.
背景
由于基础疾病以及免疫抑制的需求，肺移植术后患者尤其容易发生胃肠道（GI）并发症，这些并发症可能会对长期预后产生负面影响。本研究评估了肺移植术后GI并发症的发生率及其影响，并旨在确定危险因素。
方法
对1993年1月至2010年12月在洛桑和日内瓦大学医院连续进行的227例单肺和双肺移植进行回顾性分析。采用逻辑回归分析来检验潜在影响变量对总体、严重及需要手术治疗的并发症等二元结局的影响，随后建立多因素逻辑回归模型。
结果
本研究最终纳入205例患者，22例因再次移植、多器官移植或数据集不完整而被排除。127例（62%）患者出现GI并发症。胃食管反流病是最常见的并发症（22.9%），其次是炎症性或感染性结肠炎（20.5%）和胃轻瘫（10.7%）。83例（40.5%）患者出现严重GI并发症（Dindo/Clavien III - V级），4例（2.0%）患者死亡。多因素分析确定双肺移植（p = 0.012）和早期（1993 - 1998年）移植期（p = 0.008）是发生严重GI并发症的独立危险因素。43例（21%）患者需要手术治疗，如结肠切除术、胆囊切除术和胃底折叠术，分别占患者的6.8%、6.3%和3.9%。多因素分析确定Charlson合并症指数≥3是发生需要手术治疗的GI并发症（p = 0.015）的独立危险因素。
结论
肺移植术后GI并发症很常见。在我们的移植中心，结局相当令人鼓舞。
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