手术联合间充质干细胞治愈胃肠道移植物抗宿主病合并不完全性肠梗阻1例并文献综述

Surgery combined with mesenchymal stem cells in the treatment of intestinal graft versus host disease with incomplete intestinal obstruction:a case report and literature review

目的探讨异基因造血干细胞移植术(allo-HSCT)后胃肠道移植物抗宿主病(GVHD)并发不完全性肠梗阻的临床特征及治疗手段。方法回顾性分析1例中间型β地中海贫血合并自身免疫性溶血性贫血患儿,行非血缘相合allo-HSCT后合并胃肠道GVHD并发不完全性肠梗阻的临床表现、治疗过程和转归。结果该患儿胃肠道GVHD表现为顽固性阵发性腹痛、持续性腹泻,应用多种免疫抑制剂效果欠佳,联合间充质干细胞(MSC)输注,腹泻症状缓解,但阵发性腹痛加剧,进食少,间有呕吐胃内容物。在移植后9个月时拟诊不完全性肠梗阻,剖腹探查并行回肠狭窄处的部分肠段切除术,术后患儿腹痛、腹泻逐渐消失。结论胃肠道GVHD是allo-HSCT后严重的并发症之一,联合规律输注MSC可改善GVHD症状,促进肠道黏膜修复,且输注安全无毒副作用。严重胃肠道GVHD可致肠梗阻并需手术治疗,早期明确诊断,特别是对于不完全性肠梗阻的患儿,及时手术治疗是关键。

Objective To investigate the clinical features and treatment of GI-GVHD complicated with incomplete intestinal obstruction after allo-HSCT. Methods The clinical features of a child with β-thalassemia intermedia associated with autoimmune hemolytic anemia, who developed GI-GVHD complicated with incomplete intestinal obstruction after unrelated allo-HSCT were retrospectively analyzed, and the treatment and outcome were reviewed. Results The intestinal graft-versus-host disease in this patient was intractable, paroxysmal abdominal pain, persistent diarrhea and the immunosuppressive therapy was not effective. Although the diarrhea relief with mesenchymal stem cells treatment, the abdominal pain increased, eating less, vomiting sometimes. 9 months after transplantation, incomplete intestinal obstruction was diagnosed. After laparotomy and partial bowel resection, the abdominal pain and diarrhea disappeared gradually. Conclusions GI-GVHD is one of the serious complications of allogeneic hematopoietic stem cell transplantation. MSC therapy can relieve GVHD and it is safe. Sever GI-GVHD can cause intestinal obstruction and require surgical treatment.Early diagnosis and timely surgical treatment, especially for incomplete intestinal obstruction in children,are the key treatment.