肾移植术后肠道并发症临床诊治分析

目的 探讨肾移植术后肠道并发症的病因诱因、临床特点及诊治方案。 方法 回顾性分析47例肾移植术后肠道并发症患者的临床资料，总结其发病病因诱因、临床特点及治疗经验。 结果 肾移植术后肠道并发症患者47例，随访3~36个月（中位时间18个月），并发症包括上消化道出血4例，下消化道出血1例，急性肠炎25例，慢性肠炎12例，肠结核1例，结肠癌1例，肠梗阻3例。消化道出血患者中，4例发生在大剂量使用肾上腺皮质激素后，2例出现出血性休克。急性肠炎患者中，7例在肾移植围手术期首次服用免疫抑制剂，余18例有不洁饮食或着凉史，4例检测病原菌阳性。慢性肠炎患者中，12例麦考酚酸或他克莫司血药浓度升高，水、电解质、酸碱失衡，2例病原菌阳性，8例伴重度贫血。1例肠梗阻发生在肾移植围手术期，2例出现中毒性休克。根据疾病类型及病情严重程度，分别积极实施对症及病因治疗。47例患者中，45例治愈，2例死亡，死因分别为下消化道出血和结肠癌肺转移引起呼吸衰竭，3例出现移植肾功能不全。 结论 肾移植术后肠道并发症表现多样，与肠道稳态失衡有关，病情有急有缓，均可对移植肾功能造成不同程度的损害，合并严重并发症时预后不良，为降低其发生率，提高治愈率，积极预防和果断处理十分重要。

Clinical diagnosis and treatment of intestinal complications after renal transplantation

Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of intestinal complications after renal transplantation. Methods Clinical data of 47 patients presenting with intestinal complications following renal transplantation were retrospectively analyzed. The etiology, clinical characteristics and treatment experience of intestinal complications were summarized. Results Forty-seven patients with intestinal complications after renal transplantation were followed up for 3-36 months with the median time of 18 months. Intestinal complications included the upper gastrointestinal bleeding in 4 cases, the lower gastrointestinal bleeding in 1 case, acute enteritis in 25 cases, chronic enteritis in 12 cases, intestinal tuberculosis in 1 case, colon cancer in 1 case, and intestinal obstruction in 3 cases, respectively. Among patients with gastrointestinal bleeding, the symptoms occurred after the use of high-dose adrenal cortex hormone in 4 cases and 2 patients developed hemorrhagic shock. In patients with acute enteritis, 7 cases received immunosuppressants for the first time during the perioperative period of renal transplantation, the remaining 18 patients had dirty diet or catched cold and 4 were positive for pathogens. Among patients with chronic enteritis, plasma concentrations of mycophenolic acid or tacrolimus were elevated in 12 patients, water, electrolyte, and acid-base imbalance was detected, 2 were positive for pathogens, and 8 were accompanied with severe anemia. One case of intestinal obstruction occurred during the perioperative period of renal transplantation, and 2 cases experienced toxic shock. According to the type and severity of disease, symptomatic and etiological treatments were actively implemented. In the 47 patients, 45 were cured and 2 died from the lower gastrointestinal bleeding and respiratory failure caused by lung metastasis of colon cancer. Three patients suffered from transplanted renal insufficiency. Conclusions The intestinal complications after renal transplantation are diverse, which are correlated with the imbalance of intestinal homeostasis. Both the acute and chronic diseases can cause various degrees of damage to the function of transplanted kidneys. Clinical prognosis is poor at the presence of severe complications. Active prevention and management should be implemented to reduce the risk of postoperative complications and enhance the cure rate.