Early severe digestive complications after lung transplantation.
Early severe digestive complications after lung transplantation.
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肺移植后早期严重的消化道并发症。
DOI：
10.1016/j.ejcts.2011.02.069
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Y. Castier
中科院分区：
文献类型：
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作者：
B. Lahon;P. Mordant;G. Thabut;Jean;G. Dauriat;H. Mal;G. Lesèche;Y. Castier
目的：本研究旨在描述和分析本中心肺移植术后早期严重消化并发症（ESDC）。方法：回顾性研究包括351例1988年3月至2009年12月期间在本中心行无体外循环（CPB）肝移植的患者。共有86辆双lt和265辆单lt。esdc被定义为(1)在移植后的前30天或最初住院期间（如果时间更长）发生的并发症；(2)累及胃肠道的；(3)危及生存或需要侵入性治疗的。分析了患者特征、相关危险因素以及ESDC对早期预后的影响。结果：26例患者在肝移植后30天或更长时间的初次住院期间发生26例esdc（发生率7.4%，性别比M/F 66%，平均年龄56±6岁）。包括10例急性胆囊炎（38%），4例血管性胆管炎（15%），3例胃十二指肠溃疡穿孔（11%），3例消化道穿孔（11%），2例肠道闭塞（8%），2例肠系膜缺血（8%）和2例急性胰腺炎（8%）。ESDC在术后平均随访14天（5-46天）后发生，20例（77%）患者需要紧急手术治疗，显著延长了平均住院时间（有ESDC的患者96天vs没有ESDC的患者55天，p≪0.0001），并导致5例（19%）患者死亡。手术治疗包括胆囊切除术（n= 11）、肠切除术（n= 3）、溃疡手术（n= 2）、结肠次全切除术（n= 2）、Hartmann手术（n= 1）和开放式腹腔镜检查（n= 1）。在单因素和多因素分析中发现，年龄和双侧LT是ESDC的重要危险因素。结论：无CPB的LT患者发生ESDC的比例为7.4%，ESDC与住院时间延长有关。相关的危险因素包括年龄较大和双侧肝移植，干扰了目前关于受体选择和手术选择的争论。
Objective:This study aimed to describe and to analyze early severe digestive complications (ESDC) after lung transplantation (LT) in our center.Methods:A retrospective study included 351 patients, who underwent LT without cardiopulmonary bypass (CPB) at our center between March 1988 and December 2009. There were 86 double LTs and 265 single LTs. ESDCs were defined as complications (1) occurring during the first 30 days after transplantation or during initial hospitalization if longer; (2) involving the gastrointestinal tract; and (3) jeopardizing survival or requiring invasive therapeutic procedure. Patients’ characteristics, associated risk factors, and influence of ESDC on early outcome have been analyzed.Results:During the first 30 days after LT or initial hospitalization if longer, 26 ESDCs occurred in 26 patients (rate 7.4%, sex ratio M/F 66%, mean age 56 ± 6 years). This included 10 acute cholecystitis (38%), four angiocholitis (15%), three perforated gastroduodenal ulcers (11%), three digestive perforations (11%), two intestinal occlusions (8%), two mesenteric ischemia (8%), and two acute pancreatitis (8%). ESDC occurred after a mean postoperative follow-up of 14 days (5–46), required emergency surgical treatment in 20 cases (77%), significantly prolonged the mean duration of hospitalization (96 days with ESDC vs 55 days without ESDC,p≪ 0.0001), and was responsible for death in five cases (19%). Surgical treatment included cholecystectomy (n= 11), bowel resection (n= 3), ulcer surgery (n= 2), subtotal colectomy (n= 2), Hartmann procedure (n= 1), and open coelioscopy (n= 1). Age and bilateral LT were found to be significant risk factors for ESDC in both uni- and multivariate analyses.Conclusion:ESDC occurred in 7.4% of patients after LT without CPB, and was responsible for longer in-hospital stay. Relevant risk factors included older age and bilateral LT, interfering with current debate regarding recipients’ selection and procedure’s choice.