肾移植术后慢性腹泻的临床诊治分析

摘要

目的：探讨肾移植术后患者慢性腹泻的诊治方案。方法回顾性分析2007年1月至2014年6月在西京医院泌尿外科实施同种异体肾移植术并规律随访的353例患者中发生慢性腹泻者的临床资料。观察肾移植术后慢性腹泻的发生情况（发生率、发生时间、病程、并发症），记录慢性腹泻患者的一般状况与辅助检查指标变化（体重指数、贫血情况、辅助检查指标），以及患者的治疗经过与预后。结果353例肾移植患者中15例（4.2％）发生慢性腹泻，给予积极对症、病因治疗的时间为（15±7）d，腹泻期间死亡2例（分别死于消化道出血和严重低钾血症猝死），其余患者的腹泻均治愈。13例患者随访期间预后良好5例，死亡2例（均死于肺部感染），移植肾失功5例，移植肾功能不全1例。结论肾移植术后慢性腹泻病因复杂，应积极对症、病因治疗，合并严重并发症者预后不良。%Objective To investigate the diagnosis and treatment regimen for patients with chronic diarrhea after renal transplantation.Methods The clinical data of 353 patients with chronic diarrhea who underwent renal allograft transplantation at Department of Urology of Xijing Hospital from January 2007 to June 2014 with regular follow-up were analyzed retrospectively.The occurrence of chronic diarrhea after renal transplantation was observed,including incidence,time of occurrence,course of disease and complications. The changes in general conditions and auxiliary examination indexes (body mass index,anemia and other auxiliary examination indexes),treatment and prognosis of the patients with chronic diarrhea were recorded. Results Fifteen cases (4.2%) of 353 renal transplant recipients had chronic diarrhea. The time of symptomatic and etiological treatment was (15 ±7 ) d.Two patients died during diarrhea (died from gastrointestinal hemorrhage and sudden death caused by severe hypokalemia respectively)and other patients were recovered.Among the 13 patients,5 cases had good prognosis,2 cases died (both died from pulmonary infection),5 cases suffered from renal allograft dysfunction and 1 case suffered from renal allograft insufficiency during the follow-up.Conclusions The etiology of chronic diarrhea after renal transplantation is complex and the patients should receive symptomatic and etiological treatment.The patients with chronic diarrhea after renal transplantation combined with severe complications have poor prognosis.