Slakey D P, Johnson C P, Cziperle D J, Roza A M, Wittmann D H, Gray D W, Roake J A, Britton J, Morris P J, Adams M B
Department of Surgery, Medical College of Wisconsin, Milwaukee, USA.
Ann Surg. 1997 Feb;225(2):217-22. doi: 10.1097/00000658-199702000-00010.
The authors determine if any aspects of the treatment of renal transplant patients with pancreatitis were of particular benefit with regard to graft and patient survival.
The incidence of pancreatitis in renal transplant patients is low (1%-2%), but the mortality of the disease approaches 100%. Although several descriptive reports have been published, there is no consensus-regarding management.
The authors conduct a retrospective chart review.
Twenty-one patients were identified with posttransplant pancreatitis (1.3% incidence). The cause of pancreatitis was presumed to be maintenance immunosuppression in all cases. Patients were classified by dynamic computed tomography (CT) scans having 1) mild/edematous disease (4 patients), 2) localized abscess or pseudocyst (6 patients), or 3) severe disease (11 patients). Patients with mild/edematous pancreatitis did well with medical management. The six patients with localized abscess or pseudocyst were successfully treated with standard operative intervention. Of the 11 patients with severe disease, 6 had several days of intensive medical management before operation, and all died. The other five patients underwent early operative intervention based principally on CT scan findings, and all survived. The latter group had multiple operations and four of five had functioning renal allografts at discharge.
The severity of pancreatitis in the posttranplant patients may be difficult to assess by clinical criteria. Dynamic CT scanning is, therefore, essential in defining the extent of disease. Early, and perhaps repeated, operations may be lifesaving in those patients having CT scan findings of severe pancreatitis.
作者确定肾移植合并胰腺炎患者的治疗措施中，是否有任何方面对移植物和患者的存活特别有益。
肾移植患者中胰腺炎的发病率较低（1%-2%），但该病的死亡率接近100%。尽管已经发表了几篇描述性报告，但在治疗管理方面尚未达成共识。
作者进行了一项回顾性病历审查。
确定了21例移植后胰腺炎患者（发病率为1.3%）。所有病例中胰腺炎的病因被推测为维持性免疫抑制。根据动态计算机断层扫描（CT）结果，患者被分为三类：1）轻度/水肿性疾病（4例），2）局限性脓肿或假性囊肿（6例），或3）重度疾病（11例）。轻度/水肿性胰腺炎患者通过药物治疗效果良好。6例局限性脓肿或假性囊肿患者通过标准手术干预成功治愈。11例重度疾病患者中，6例在手术前接受了数天的强化药物治疗，全部死亡。另外5例患者主要根据CT扫描结果接受了早期手术干预，全部存活。后一组患者接受了多次手术，5例中有4例在出院时肾移植功能良好。
移植后患者胰腺炎的严重程度可能难以通过临床标准评估。因此，动态CT扫描对于确定疾病范围至关重要。对于CT扫描显示为重度胰腺炎的患者，早期手术，甚至可能是重复手术，可能挽救生命。
