肾移植术后近期消化道大出血的手术治疗

The surgical treatment of massive gastrointestinal hemorrhage in the early renal posttransplant period.

目的 总结肾移植术后消化道大出血的手术治疗体会及保护移植肾功能的措施。方法 回顾性分析1981年以来肾移植术后消化道大出血的手术指征、围手术期治疗及移植肾功能情况。结果 共施行同种异体肾移植术 1487例次 ,6 7例术后并发消化道出血 ,其中 3例因出血反复发作而行手术治疗 ,诊断为上消化道应激性溃疡 ,手术处理后得以控制出血。结论 及时、彻底地控制出血 ,适当调整免疫抑制剂的用量 ,积极预防肺部感染 ,对于确保移植肾安全渡过消化道大出血这一危险时期是必需的。

Objective To summarize the experience in surgical management for massive gastrointestinal hemorrhage following renal transplantation in order to improve graft survival rate.Methods Clinical data of surgical therapy including operative indication,perioperative treatment and graft function were retrospectively analyzed.Results Between September 1981 to December 2000,1487 patients with terminal renal insufficiency received kidney transplantation in our transplant center,67 of recipients developed gastrointestinal hemorrhage.Most of the bleeding cases were effectively controlled by medical therapy;only 3 cases by surgical treatment because of repeated bleeding.An emergent gastroscope was performed and a stress ulcer was found in all 3 patients.The bleeding was finally successfully controlled by surgical resection with billroth Ⅱ-Moynihan procedure.Conclusion Prompt management of hemorrhage,adequate adjustment of immunosuppressants and prophylaxis of pulmonary infection are needed to pull through this bleeding crises in renal allograft recipients.