肾移植术后急性胰腺炎12例诊治经验

Management of acute pancreatitis after kidney transplantation: our experiences of 12 patients

目的总结肾移植术后急性胰腺炎的临床诊治体会。方法回顾性分析2007年9月至2017年12月12例肾移植术后发生急性胰腺炎受者的临床资料。结果12例受者均在出现上腹部疼痛后72 h内确诊为急性胰腺炎,其中4例肾移植术后1周内发病,经非手术治愈2例,行胰腺周围间隙穿刺引流治愈2例;8例移植1年后发病,经非手术治疗治愈3例,手术治疗5例,1例接受腹腔镜胆囊切除术,1例经内镜逆行胰胆管造影下胆道取石治疗,2例接受胰腺周围间隙穿刺引流术,1例接受胰腺周围坏死组织清创引流术;1例因发生多器官功能衰竭而死亡。结论肾移植术后急性胰腺炎的发生可能与免疫抑制剂干扰血脂和胰腺微循环有关,对于胆石症相关胰腺炎者应手术清除诱因,非结石性重症胰腺炎优选微创介入穿刺引流,必要时手术治疗。

Objective To summarize the experiences of diagnosing and treating acute pancreatitis (AP) after kidney transplantation. Methods From September 2007 to December 2017, clinical data were retrospectively analyzed for 12 AP patients after kidney transplantation. Results They were diagnosed as AP within 72 h after an onset of abdominal pain. Among 4 recurrent cases within 1 week post-transplantation, the curative interventions included non-operative therapy (n=2) and peripancreatic puncture & drainage (n=2). AP occurred at 1 year post-transplantation (n=8). Three cases were cured non-surgically while another 5 cases underwent surgery. The procedures included laparoscopic cholecystectomy (n=1), endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis (n=1) and peripancreatic puncture & drainage (n=2). One patient died after surgical debridement for adjacent pancreatic tissue. Conclusions After kidney transplantation, the occurrence of AP may be associated with immunosuppressants interfering with triglyceride metabolism and pancreatic microcirculation. For those with cholelithiasis-related pancreatitis, surgical removal of precipitating factor is required. Mini-invasive puncture and drainage are preferred for severe non-gallstone pancreatitis while surgery is performed whenever necessary.