Varga M, Kudla M, Vargova L, Fronek J
Universitätsklinik für Chirurgie, Landeskrankenhaus Salzburg-Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich; Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Transplant Proc. 2016 Jul-Aug;48(6):2072-5. doi: 10.1016/j.transproceed.2016.02.079.
The aim of our study was to evaluate the rate of surgical complications, patient outcomes, and impact on graft function in renal transplant recipients in whom cholecystectomy for acute cholecystitis was performed.
We reviewed data on transplant patients from January 1, 2006, to December 31, 2013. The subgroup of patients who required subsequent cholecystectomy for acute cholecystitis was assessed, and their data were further analyzed.
Thirty-one patients who underwent cholecystectomy for acute cholecystitis after renal transplantation were included in the study. Clinical signs such as pain in the right upper quadrant, temperature >38°C, and elevation in bilirubin levels occurred in 20 (64.5%), 8 (25.8%), and 3 (9.7%) patients, respectively. Ultrasound signs of acute cholecystitis were present in 27 patients (87.1%). In terms of laboratory values, white blood cell counts >10 × 10(9)/L occurred in 17 patients (54.8%), and C-reactive protein levels >40 mg/L were reported in 21 patients (67.7%). The conversion rate to open surgery was 32.3% (10 patients). In 13 cases, acalculous cholecystitis was present (41.9%). The average serum creatinine level 1 year after cholecystectomy had no statistically significant differences. One patient required temporary dialysis during the postoperative period (with subsequent graft recovery), and 1 graft was lost.
Acute cholecystitis in kidney transplant recipients is a serious complication, with frequent difficulties related to evaluation and diagnosis. Because clinical signs could be very mild compared with severity of gallbladder affliction, there is little room if any for conservative treatment in these patients. We have not noticed adverse impact of acute cholecystitis on 1-year graft function.
我们研究的目的是评估因急性胆囊炎而行胆囊切除术的肾移植受者的手术并发症发生率、患者预后以及对移植肾功能的影响。
我们回顾了2006年1月1日至2013年12月31日期间移植患者的数据。对因急性胆囊炎而需要后续行胆囊切除术的患者亚组进行评估，并对其数据进行进一步分析。
本研究纳入了31例肾移植后因急性胆囊炎而行胆囊切除术的患者。右上腹疼痛、体温>38°C以及胆红素水平升高这些临床体征分别出现在20例（64.5%）、8例（25.8%）和3例（9.7%）患者中。27例患者（87.1%）存在急性胆囊炎的超声征象。在实验室检查值方面，17例患者（54.8%）白细胞计数>10×10⁹/L，21例患者（67.7%）C反应蛋白水平>40mg/L。转为开放手术的比例为32.3%（10例患者）。13例患者存在无结石性胆囊炎（41.9%）。胆囊切除术后1年的平均血清肌酐水平无统计学显著差异。1例患者在术后需要临时透析（随后移植肾功能恢复），1例移植肾失功。
肾移植受者的急性胆囊炎是一种严重并发症，在评估和诊断方面常常存在困难。由于与胆囊病变的严重程度相比临床体征可能非常轻微，这些患者几乎没有保守治疗的空间。我们未注意到急性胆囊炎对1年移植肾功能有不良影响。
