艾滋病合并结直肠癌手术的安全性评价

Operative safety of HIV-infected patients with colorectal cancer

目的探索不同程度免疫缺陷的艾滋病合并结直肠癌患者的手术安全性。方法前瞻性收集2012年1月至2015年12月期间于成都市公共卫生临床医疗中心行结直肠癌根治术的结直肠癌患者56例,根据术前1 d(D0)的CD_4^+T细胞计数将HIV阳性患者分为3组(CD_4^+T细胞计数>500个/μL归为HIV阳性Ⅰ组;CD_4^+T细胞计数为200~500个/μL归为HIV阳性Ⅱ组;CD_4^+T细胞计数<200个/μL归为HIV阳性Ⅲ组),另将HIV阴性者归为HIV阴性组。检测并比较4组不同时间点外周静脉血中的白细胞计数、中性粒细胞百分比、淋巴细胞百分比、CD_4^+T细胞计数及CD_8^+T细胞计数,同时比较HIV阳性组和HIV阴性组患者的术后常见并发症、术后各时点癌胚抗原(CEA)值及术后生存情况。结果 56例患者中,HIV阳性26例(HIV阳性组,再分为HIV阳性Ⅰ组8例,HIV阳性Ⅱ组10例,HIV阳性Ⅲ组8例)。重复测量资料的方差分析结果表明,不同组别、不同时点组患者的白细胞计数、中性粒细胞百分比、淋巴细胞百分比及CD_8^+T细胞计数的差异均无统计学意义(P>0.05);4组患者的CD_4^+T细胞计数随时间均呈现先下降后回升的变化趋势(P<0.05),且不同组别的CD_4^+T细胞计数下降和回升的速度及幅度不同(P<0.05)。术后HIV阳性组及HIV阴性组患者的CEA大致呈现下降趋势,时点效应有统计学意义(P<0.05),但组别和组别及时点的交互效应均无统计学意义(P>0.05)。HIV阳性组和HIV阴性组患者的手术时间、术中出血量、术后住院时间及各并发症发生率(包括切口感染、术后肺部感染及术后机会性感染)比较差异均无统计学意义(P>0.05)。HIV阴性组及HIV阳性组患者的生存曲线比较差异无统计学意义(P>0.05)。结论不同程度免疫缺陷的艾滋病合并结直肠癌患者在实施结直肠癌根治术后,细胞免疫功能均在一段时间内表现出"先抑制后恢复"的现象;HIV感染者与非感染者术后的常见并发症的发生率及生存率相似。在恰当的围手术期处理前提下,对艾滋病合并结直肠癌患者施行手术是安全的。

Objective To explore the operative safety of HIV-infected patients with colorectal cancer in different degrees of immunodeficiency.Methods A total of 56 patients,including 26 cases of HIV positive（HIV-positive group）and 28 cases of HIV negative（HIV-negative group）,who underwent radical operation for colorectal cancer between January 2012 and December 2015,were enrolled in our study.We divided HIV-positive patients into three groups according to CD4~＋ T cells count in peripheral venous blood before 1 day（D0） of the surgery（HIV-positive Ⅰgroup with CD4~＋ T cells count 500/μL,HIV-positive Ⅱgroup with CD4~＋ T cells count among 200–500/μL,and HIV-positive Ⅲgroup with CD4~＋ T cells count 200/μL）.Non-infective patients were enrolled in HIV-negative group.Leukocyte count,neutrophil percentage,lymphocyte percentage,CD4~＋ T cells subsets count,and CD8~＋ T cells subsets count of the 4 groups in different time points were tested.In addition,we compared postoperative complications,carcinoembryonic antigen（CEA）,and postoperative survival rate between the HIV-positive group and the HIV-negative group.Results In 56 cases,there were 26 cases of HIV-positive patients（including 10 cases of HIV-positive Ⅰ group,8 cases of HIV-positive Ⅱgroup and 10 cases of HIV-positive Ⅲ group）.Variance results about repeated measurement data showed that,variation of leukocyte count,neutrophil percentage,lymphocyte percentage,and CD8~＋ T cells count among 4 groups after surgery had no statistical significance（P0.05）,in addition there was no significant on time effect and interactive effect of time and group（P0.05）.CD4~＋ T cells count in the 4 groups showed a trend from decline to rising with time going,and the time effect had statistical significance（P0.05）.The speed and amplitude of decline and recovery of CD4~＋ T cells count were different among groups,and the group effect had statistical significance（P0.05）.CEA showed a trend of decline after surgery in both HIV-positive group and HIV-negative group,and the time effect had statistical significance（P0.05）,but the group effect and interactive effect of time and group had no statistical significance（P0.05）.No statistically significant differences in amount of blood loss,duration of surgery,postoperative stay,nor complication rate（including incision infection,pulmonary infection,and opportunistic infections after surgery） were found between the HIV-positive group and the HIV-negative group（P0.05）.The overall survival situation of the HIV-positive group and the HIVnegative group had no statistical significance（P0.05）.Conclusions Radical operation for HIV-infected patients with colorectal cancer has an impact of ＂first inhibition and recovery＂ on cellular immunity over a period of time.Incidence of postoperative complications and survival rates are similar in HIV-positive patients and HIV-negative patients.In a word,it＇s safe to have radical operation for colorectal cancer in HIV-positive patients under the proper perioperative treatment.