Feduska N J, Amend W J, Vincenti F, Melzer J S, Duca R, Garovoy M R, Salvatierra O
Am J Surg. 1984 Jul;148(1):51-7. doi: 10.1016/0002-9610(84)90288-5.
The occurrence of peptic ulcer in kidney transplant recipients treated with corticosteroids for immunosuppression is a problem of considerable magnitude and threatens both patient and graft survival. The fact that peptic ulcer usually occurs in the early months after transplantation, and that there are known risk factors including treatment for rejection, sepsis, and hepatitis, demand a high level of clinical suspicion, early and accurate diagnosis, and prompt treatment. Aggressive medical prophylaxis is important, but if it should fail prompt reduction of the dose of corticosteroids is imperative so that continued patient survival is emphasized rather than the continued survival of the transplant. Surgical intervention, when indicated, should also be prompt, and the more definitive operations such as vagotomy with pyloroplasty or gastric resection are preferred because of a lesser occurrence of reoperation among such patients. Prophylactic operations in patients with an antecedent history of peptic ulcer may provide considerable protection against the development of corticosteroid-related ulcers after transplantation.
接受皮质类固醇免疫抑制治疗的肾移植受者发生消化性溃疡是一个相当严重的问题，威胁着患者和移植物的存活。消化性溃疡通常发生在移植后的最初几个月，且已知有包括排斥反应治疗、败血症和肝炎等危险因素，这就需要高度的临床怀疑、早期准确的诊断及及时的治疗。积极的药物预防很重要，但如果预防失败，必须迅速减少皮质类固醇的剂量，以便强调患者的持续存活而非移植肾的持续存活。如有指征，手术干预也应迅速进行，由于这类患者再次手术的发生率较低，因此更倾向于选择诸如迷走神经切断术加幽门成形术或胃切除术等更具确定性的手术。有消化性溃疡既往史的患者进行预防性手术，可能会对移植后发生皮质类固醇相关溃疡起到相当大的预防作用。
