PDF(Pubmed)
Abstract：
The number of solid organ transplantations performed annually is increasing and are increasing in the following order: Kidney, liver, heart, lung, pancreas, small bowel, and uterine transplants. However, the outcomes of transplants are improving (organ survival > 90% after the 1st year). Therefore, there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen. Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems. The perioperative regulation of immunosuppression, the treatment of accompanying problems of immunosuppression, the administration of cortisol and, above all, the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients. The perioperative assessment and preparation includes evaluation of the patient\'s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis, or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes. Immunosuppression in transplant patients is associated with the use of calcineurin inhibitors, corticosteroids, and antiproliferation agents. Many times, the clinical picture is atypical, resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality. Multidetector computed tomography is of utmost importance for early diagnosis and management. Transplant recipients are prone to infections, especially specific infections caused by cytomegalovirus and Clostridium difficile, and they are predisposed to intraoperative or postoperative complications that require great care and vigilance. It is necessary to follow evidence-based therapeutic protocols. Thus, it is required that the clinician choose the correct therapeutic plan for the patient (conservative, emergency open surgery or minimally invasive surgery, including laparoscopic or even robotic surgery).
摘要：
每年进行的实体器官移植的数量正在增加，并且按以下顺序增加：肾脏，肝脏,心,肺，胰腺,小肠,和子宫移植。然而,移植的结果正在改善(第1年后器官存活率>90%).因此,普通外科医生很有可能会面临急腹症移植患者的治疗。免疫功能低下患者的手术问题可能不仅包括与移植物相关的问题，还包括与非移植物相关的问题。围手术期免疫抑制的调节，伴随的免疫抑制问题的治疗，皮质醇的管理，最重要的是,在这些患者中，了解迅速恶化的情况以及对临床表现的准确评估和解释尤为重要。围手术期评估和准备包括评估患者的心血管系统，确定患者是否患有高血压或下丘脑-垂体-肾上腺轴抑制，或患者是否有任何凝血机制异常或血栓栓塞发作。移植患者的免疫抑制与钙调磷酸酶抑制剂的使用有关，皮质类固醇,和抗增殖剂。很多时候,临床表现不典型，导致诊断和治疗的延误，并导致发病率和死亡率增加。多探测器计算机断层扫描对于早期诊断和管理至关重要。移植接受者容易感染，特别是由巨细胞病毒和艰难梭菌引起的特异性感染，并且他们容易发生术中或术后并发症，需要格外小心和警惕。有必要遵循循证治疗方案。因此，要求临床医生为患者选择正确的治疗计划(保守，紧急开放手术或微创手术，包括腹腔镜甚至机器人手术)。
