综合性医院320例HIV阳性病例手术种类及特征分析

Analysis of surgical types and clinical characteristics of 320 HIV-positive surgical cases in a general hospital

目的探讨综合性医院艾滋病病毒(HIV)阳性者的手术种类及临床特点,为综合性医院参与艾滋病防治提供依据。方法回顾性分析武汉大学中南医院2016年1月至2018年12月实施手术的HIV阳性病人的临床资料。结果 320例HIV阳性手术病人,平均年龄(44.8±13.6)岁,平均住院日(14.3±11.9)天。CD4^+T淋巴细胞(简称CD4细胞)计数中位数为323(四分位间距:184~464)个/μL,其中≤200个/μL 90例,占28.1%。与HIV感染相关的疾病及肿瘤手术64例(20.0%),非HIV相关的疾病及肿瘤手术256例(80.0%)。HIV感染相关疾病及肿瘤手术病人与非HIV相关的疾病及肿瘤手术病人比较,CD4细胞计数低(z=-4.909,P=0.000),平均住院日长(t=3.958,P=0.000),确诊时间在6个月内的达51.6%,但在手术级别分布(z=-0.441,P=0.659)差异无统计学意义。普外科手术109例,占34.1%,其次为妇产科(17.8%)、泌尿外科(13.1%)、眼科(12.8%)等,多学科参与了艾滋病的诊治。3级及以上手术205例(64.1%)。无手术严重并发症及手术死亡病例。结论 HIV阳性病人中非HIV相关的疾病及肿瘤手术增多,手术疾病谱广。对HIV阳性病人手术应持积极态度,提高HIV阳性病人的生活质量。

Objective To investigate the types and characteristics of surgery in patients with HIV-positive in a general hospital and provide a basis for doctors participation in AIDS prevention and treatment. Methods Retrospective analysis of clinical data of HIV-positive patients undergoing surgery from Jan 2016 to Dec 2018 in Zhongnan hospital affiliated to Wuhan university. Results The average age of 320 HIV-positive patients was 44.8 ±13.6 years, and the average hospitalization day was 14.3±11.9 days. The median CD4^+T lymphocyte count was [323(IQR:184-464)]/μL, with 90 cases(28.1%) is CD4^+T lymphocyte counts ≤ 200/μL. 64 patients(20.0%) received surgeries due to their HIV-related diseases and tumors and 256 cases(80.0%) had surgeries because of non-HIV-related diseases and tumors. Compared with non-HIV-related diseases and tumor surgery patients, HIV-related diseases and tumor surgery patients had low CD4 cell counts(z =-4.909, P =0.000), and longer time of the average hospitalization time(t =3.958, P =0.000), and 51.6% of the patients were diagnosed as HIV infection within 6 months, with no statistical difference in the distribution of surgical grade.(z =-0.441, P =0.659). There were 109 cases(34.1%) of general surgery, followed by obstetrics and gynecology(17.8%), urology(13.1%), and ophthalmology(12.8%), etc., with multidisciplinary involvement in the diagnosis and treatment of AIDS. There were 205 cases(64.1%) with surgical grade 3 and above, and no serious postoperative complications or death. Conclusion The number of HIV-positive patients with non-HIV-related diseases and tumor surgeries is increasing, with a wide spectrum. Doctors should take positive attitudes towards the surgery of HIV-positive patients so as to improve their quality of life.