Lerut J, Lerut T, Gruwez J A, Michielsen P, Van Renterghem I
Acta Chir Belg. 1980 Nov-Dec;79(6):383-9.
In 277 consecutive renal transplantations, 49 of 254 patients (19%) developed a gastrointestinal complication causing a mortality rate of 29% (14/49 patients). Oesophageal, gastro-duodenal, pancreatic and ileocolonic complications are reviewed and discussed. Acute gastro-duodenal ulcerations proved to be the most common problem (45--22/49 patients). The loss of allograft in this group of 22 patients was 42% (9/22 patients). To overcome their high mortality (27%--6/22 patients) efforts were made to prevent these complications. After introduction of prophylactic surgery, mortality dropped from 4 to 2%, after systematic long-term prophylactic use of cimetidine, mortality even dropped to 0%. In this last series of 52 patients only one bleeding ulcer was seen immediately after allograft nephrectomy. Ileocolonic complications in renal transplant patients, difficult to diagnose and treat, are associated with a high morbidity and lethality. In 6 patients with colonic complications, 4 could be saved by early and aggressive surgery (67% survival rate). Two recipients developed a de novo gastrointestinal malignancy. Early, accurate, diagnosis and surgical therapy of gastro-intestinal complications after renal transplantation are directly related to the graft and/or patient survival rate. Every effort is therefore necessary to prevent these complications.
在277例连续性肾移植中，254例患者中有49例（19%）发生了胃肠道并发症，死亡率为29%（49例患者中有14例）。对食管、胃十二指肠、胰腺和回结肠并发症进行了综述和讨论。急性胃十二指肠溃疡被证明是最常见的问题（49例患者中有22例）。这22例患者中移植肾丢失率为42%（22例患者中有9例）。为了降低其高死亡率（27%，22例患者中有6例），已努力预防这些并发症。采用预防性手术后，死亡率从4%降至2%，在长期系统性预防性使用西咪替丁后，死亡率甚至降至0%。在这最后一组52例患者中，仅在移植肾切除术后立即发现1例出血性溃疡。肾移植患者的回结肠并发症难以诊断和治疗，其发病率和致死率都很高。在6例结肠并发症患者中，4例通过早期积极手术得以挽救（生存率67%）。2例受者发生了新发胃肠道恶性肿瘤。肾移植后胃肠道并发症的早期、准确诊断及手术治疗与移植肾和/或患者生存率直接相关。因此，必须尽一切努力预防这些并发症。
