Sigurdsson L, Reyes J, Putnam P E, del Rosario J F, Di Lorenzo C, Orenstein S R, Todo S, Kocoshis S A
Department of Surgery, University of Pittsburgh, Children's Hospital of Pittsburgh and The Thomas E. Starzl Transplantation Institute, Pennsylvania 15213-2583, USA.
Am J Gastroenterol. 1998 Feb;93(2):207-11. doi: 10.1111/j.1572-0241.1998.00207.x.
Intestinal transplantation has become an option as a treatment for permanent intestinal failure. Endoscopy is an essential tool in assessing the intestinal allograft after intestinal transplantation. The aim of this study was to analyze our experience using endoscopy in intestinal transplant recipients.
This was a retrospective review of endoscopic and histological reports in 41 children who received an intestinal transplant between 1990 and 1995 at Children's Hospital of Pittsburgh.
A total of 1273 endoscopies was performed of which 760 were ileoscopies via allograft ileostomy, 273 were upper endoscopies, and 240 were colonoscopies. One hundred four rejection episodes were documented histologically in 32 patients, 6 days to >4 yr after transplantation. Most episodes were mild and easily treated with increased immunosuppression; however, severe rejection with mucosal exfoliation was seen in nine patients. Rejection sometimes involved only part of the allograft. Endoscopic appearance alone without biopsies was sensitive enough to diagnose only 63% of the rejection episodes. Epstein-Barr and cytomegalovirus infections occurred in 11 and eight patients, respectively, and involved both native bowel and allograft in some. Complications of endoscopy were few: one perforation, three episodes of bleeding, and three episodes of transient respiratory compromise.
Endoscopy is an essential tool in the postoperative assessment of intestinal transplant recipients. Frequent surveillance ileoscopies with biopsies should be performed after transplantation. If patients clinically deteriorate with fever, diarrhea, bacteremia, or gastrointestinal bleeding and a clear cause is not elucidated by ileoscopy, an upper endoscopy with biopsies is indicated.
肠道移植已成为治疗永久性肠衰竭的一种选择。内镜检查是评估肠道移植后同种异体肠道移植物的重要工具。本研究的目的是分析我们在肠道移植受者中使用内镜检查的经验。
这是一项对1990年至1995年期间在匹兹堡儿童医院接受肠道移植的41名儿童的内镜和组织学报告的回顾性研究。
共进行了1273次内镜检查，其中760次是通过同种异体回肠造口术进行的回肠镜检查，273次是上消化道内镜检查，240次是结肠镜检查。32例患者在移植后6天至4年以上经组织学记录有104次排斥反应发作。大多数发作较轻，通过增加免疫抑制很容易治疗；然而，9例患者出现了伴有黏膜剥脱的严重排斥反应。排斥反应有时仅累及部分同种异体移植物。仅内镜表现而无活检时，诊断排斥反应发作的敏感性仅为63%。分别有11例和8例患者发生了EB病毒和巨细胞病毒感染，部分患者同时累及原肠和同种异体移植物。内镜检查的并发症很少：1例穿孔、3次出血发作和3次短暂性呼吸功能不全发作。
内镜检查是肠道移植受者术后评估的重要工具。移植后应频繁进行带活检的监测性回肠镜检查。如果患者出现发热、腹泻、菌血症或胃肠道出血等临床恶化情况，且回肠镜检查未明确病因，则应进行带活检的上消化道内镜检查。
