器官移植2025，Vol.16Issue(3)：467-473,7.DOI:10.12464/j.issn.1674-7445.2025079
肾移植术后并发消化道出血的单中心诊疗经验
Single-center experience in the diagnosis and treatment of gastrointestinal bleeding after renal transplantation
摘要
Abstract
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.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Key words
Renal transplantation/Gastrointestinal bleeding/Diagnosis/Treatment/Gastric ulcer/Duodenal ulcer/Esophageal varices/Renal function分类
医药卫生引用本文复制引用
林颖,徐敏仪,陶金..肾移植术后并发消化道出血的单中心诊疗经验[J].器官移植,2025,16(3):467-473,7.基金项目
国家自然科学基金青年科学基金项目(82100558) （82100558）
广州市科技计划项目(2024A03J0095) （2024A03J0095）
