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目的:提高对肾移植术后消化系统并发症的预防及早期处理的认识. 方法:回顾性分析我科1994-01/2003-12肾移植术后824例905例次消化系统并发症. 结果:术后合并消化系统疾病442例次(48.8%),其中肝功能异常236例(26.1%)(1例因CMV病致重症肝炎死亡),急性胃黏膜病变37例(4.1%),均在术后3-5 mo内发生,另有1例(1.1‰)出现上消化道出血伴反复呕吐及黑便,最终因呕吐胃内容物导致窒息抢救无效死亡.腹泻165例(18.2%), 其中慢性腹泻28例(3.1%),肠梗阻1例(1.1‰),出血性肠坏死1例(1.1‰),肠结核1例(1.1‰),消化系统肿瘤(肠系膜非霍奇金淋巴瘤)1例(1.1‰). 结论:消化系统并发症是肾移植接受者主要并发症,合理使用免疫抑制剂、个体化处理可以减少消化系统并发症的发生.肾移植术后早期腹泻等症状主要是由MMF等药物或真菌感染所致.肾移植术后应重视上消化道出血,早期发现并予制酸剂及时处理预后较好.一些少见的消化系统并发症如肠梗阻、肠坏死、肠系膜淋巴结结核、消化系肿瘤、肠息肉也应该加以重视.
OBJECTIVE: To raise awareness of prevention and early treatment of digestive system complications after renal transplantation.Methods: A retrospective analysis of 824 cases of 905 cases of digestive system complications after renal transplantation in our department from January 1994 to December 2003 was performed.Results: There were 442 cases (48.8%) of digestive system diseases after operation, of which 236 cases (26.1%) had liver dysfunction (1 died of severe hepatitis due to CMV disease) and 37 cases (4.1%) of acute gastric mucosal lesions were undergone surgery Occurred in 3-5 months, while another 1 case (1.1 ‰) appeared upper gastrointestinal bleeding with recurrent vomiting and melena, eventually vomiting stomach contents cause asphyxiation and rescue ineffective death.Diarrhea in 165 cases (18.2%), of which chronic Diarrhea in 28 cases (3.1%), intestinal obstruction in 1 case (1.1 ‰), hemorrhagic intestinal necrosis in 1 case (1.1 ‰), intestinal tuberculosis in 1 case (1.1 ‰), digestive system tumors (mesentery non-Hodgkin’s lymphoma) (1.1 ‰) .Conclusion: The complications of the digestive system are the main complication of renal transplant recipients, the rational use of immunosuppressive agents, individualized treatment can reduce the incidence of digestive complications.Diagnosis of early diarrhea after renal transplantation is mainly caused by MMF and other drugs or fungal infections caused by renal transplantation should pay attention to upper gastrointestinal bleeding, early detection and antacid timely The prognosis is good. Some rare digestive complications such as intestinal obstruction, intestinal necrosis, mesenteric lymph node tuberculosis, gastrointestinal cancer, intestinal polyps should also be attention.