Colon R, Frazier O H, Kahan B D, Radovancevic B, Duncan J M, Lorber M I, Van Buren C T
Division of Surgery, Texas Heart Institute, Houston 77225.
Surgery. 1988 Jan;103(1):32-8.
With the advent of cyclosporine A, heart transplantation has become a widely accepted treatment for patients with end-stage cardiac disease that is not amenable to medical or surgical treatment. Between July 1982 and December 1985, 86 heart transplantations were performed at the Texas Heart Institute with cyclosporine A and prednisone used for immunosuppression. Thirty patients had complications requiring general surgical consultation. The pancreas and biliary tracts were most commonly affected. Pancreatitis developed in sixteen patients; five patients required operative intervention, resulting in a 40% mortality rate. Five of nine patients with cholecystitis required cholecystectomy. All patients survived the procedures. Other gastrointestinal complications included colonic ileus, bowel perforation, gastrointestinal bleeding, gastric outlet obstruction, and perirectal abscess. Patients who have undergone cardiac transplantation are susceptible to life-threatening infections and are at risk of serious complications requiring general surgical intervention. Better results can be obtained in these complex clinical situations when complications are identified early and managed aggressively through the adjustment of immunosuppression, adequate selection of antimicrobial agents, and proper timing of surgical intervention.
随着环孢素A的出现，心脏移植已成为终末期心脏病患者广泛接受的一种治疗方法，这些患者不适合药物或手术治疗。1982年7月至1985年12月期间，德克萨斯心脏研究所进行了86例心脏移植手术，使用环孢素A和泼尼松进行免疫抑制。30例患者出现并发症，需要普通外科会诊。胰腺和胆道最常受到影响。16例患者发生胰腺炎；5例患者需要手术干预，死亡率为40%。9例胆囊炎患者中有5例需要行胆囊切除术。所有患者手术均存活。其他胃肠道并发症包括结肠梗阻、肠穿孔、胃肠道出血、胃出口梗阻和直肠周围脓肿。接受心脏移植的患者易发生危及生命的感染，并有发生需要普通外科干预的严重并发症的风险。在这些复杂的临床情况下，如果能早期发现并发症，并通过调整免疫抑制、合理选择抗菌药物和适时进行手术干预积极处理，就能取得更好的效果。
