摘要
目的分析肾移植术后并发消化道出血患者的临床特征并总结诊疗经验。方法收集中山大学附属第三医院在2015年1月至2025年1月期间收治的16例肾移植术后出现消化道出血患者的临床资料,包括临床表现、实验室检查及胃肠镜等辅助检查结果,分析患者的出血部位、病因、治疗方案及转归情况,并总结复习相关文献。结果16例消化道出血患者中12例上消化道出血(3例食管、7例胃、2例十二指肠),4例下消化道出血(2例回肠、2例肛门)。16例消化道出血患者中,4例下消化道出血均表现为便血;12例上消化道出血,其中2例患者仅表现为大便潜血阳性、血红蛋白下降,无呕血、黑便等症状,9例患者表现为黑便,1例患者表现呕血。16例患者的血红蛋白水平为(71±18)g/L,其中1例出现休克症状,9例出现头晕、乏力、胸闷等贫血症状,6例一般情况较好。16例患者中10例消化道出血量较少,一般情况稳定,药物可治愈;2例患者胃镜提示消化性溃疡且存在裸露血管,予钛夹夹闭血管止血治疗;1例患者胃镜提示贲门撕裂,予钛夹夹闭撕裂处止血;1例患者胃镜提示食管静脉曲张破裂出血,予内镜下曲张静脉套扎治疗;1例患者内痔出血,择期行吻合器痔上黏膜环形切除术;1例患者急诊全腹部增强CT提示回肠活动性出血,予肠系膜动脉腔内栓塞术治疗。16例患者中1例患者因合并大面积脑梗死昏迷,自动出院,其余患者出血情况均治愈并出院,预后良好。结论肾移植术后并发消化道出血临床表现多样、病情轻重不一、病因众多,应积极早期诊断及治疗。除药物治疗外,必要时可通过内镜、介入或外科手术治疗,提高诊疗效果,最大程度降低消化道出血对移植肾造成的功能损害。
Objective To analyze the clinical characteristics of patients with gastrointestinal bleeding after renal transplantation and summarize the diagnostic and therapeutic experience.Methods Clinical data of 16 patients with gastrointestinal bleeding after renal transplantation admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to January 2025 were collected,including clinical manifestations,laboratory tests and auxiliary examination results such as gastroscopy and colonoscopy.The bleeding sites,causes,treatment plans and outcomes of the patients were analyzed,and relevant literature was reviewed.Results Among the 16 patients with gastrointestinal bleeding,12 had upper gastrointestinal bleeding(3 with esophageal bleeding,7 with gastric bleeding and 2 with duodenal bleeding)and 4 had lower gastrointestinal bleeding(2 with ileal bleeding and 2 with anal bleeding).Among the 16 patients,the 4 with lower gastrointestinal bleeding all presented with hematochezia.Of the 12 with upper gastrointestinal bleeding,2 patients only had positive fecal occult blood and decreased hemoglobin levels without hematemesis or melena,9 patients had melena and 1 patient had hematemesis.The hemoglobin levels of the 16 patients were(71±18)g/L.One patient had symptoms of shock,9 had symptoms of anemia such as dizziness,fatigue and chest tightness,and 6 had good general conditions.Among the 16 patients,10 had mild gastrointestinal bleeding and stable general conditions,which were curable by drugs.Two patients with peptic ulcers and exposed vessels on gastroscopy were treated with hemostasis by titanium clips.One patient with gastroesophageal tear was treated with hemostasis by titanium clips.One patient with esophageal variceal rupture bleeding was treated with endoscopic variceal ligation.One patient with hemorrhoidal bleeding underwent selective annual resection of the superior hemorrhoidal mucosa with stapled hemorrhoidopexy.One patient with active ileal bleeding on emergency enhanced abdominal CT was treated with endovascular embolization of the mesenteric artery.One patient was discharged automatically due to coma caused by extensive cerebral infarction,and the remaining patients were all cured and discharged with good prognosis.Conclusions Gastrointestinal bleeding after renal transplantation has diverse clinical manifestations,varying severity and many causes.Early diagnosis and treatment should be actively carried out.In addition to drug therapy,endoscopic,interventional or surgical treatment may be used when necessary to improve the diagnostic and therapeutic effects and minimize the functional damage of gastrointestinal bleeding to the transplant kidney.
作者
林颖
徐敏仪
陶金
Lin Ying;Xu Minyi;Tao Jin(Department of Gastroenterology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《器官移植》
北大核心
2025年第3期467-473,共7页
Organ Transplantation
基金
国家自然科学基金青年科学基金项目(82100558)
广州市科技计划项目(2024A03J0095)。
关键词
肾移植
消化道出血
诊断
治疗
胃溃疡
十二指肠溃疡
食管静脉曲张
肾功能
Renal transplantation
Gastrointestinal bleeding
Diagnosis
Treatment
Gastric ulcer
Duodenal ulcer
Esophageal varices
Renal function
作者简介
林颖(ORCID 0000-0003-3978-882X),硕士,副主任医师,研究方向为肝硬化及炎症性肠病方向,Email:liny35@mail.sysu.edu.cn;通信作者:陶金(ORCID 0000-0002-4027-0852),博士,主任医师,研究方向为肝硬化及炎症性肠病方向,Email:taojin3@mail.sysu.edu.cn。
