HIV阳性患者合并泌尿系统疾病的手术处理

目的:探讨H IV阳性合并泌尿系统疾病患者的手术处理特点。方法:回顾分析1996年4月~2004年5月在援外医疗队期间收治的41例患有泌尿系统疾病的H IV阳性患者的治疗经过,并总结相关经验。结果:41例患者均接受了高效抗逆转录病毒疗法(HAART)和相应手术的治疗,共随访4~30个月。31例开放手术患者中27例术后恢复良好,4例术后出现艾滋病相关综合征(ARS),其中2例为阴茎癌行阴茎部分切除术,2例为结核性脓肾行肾切除术,复查CD4+T细胞<0.2×109/L,术后4~8个月死于艾滋病。10例腔内手术患者均恢复良好。结论:患者术前通常采用HAART控制病毒的复制。术前CD4+T细胞计数对于确定手术时机及术后处理非常重要,术后应采用CD4+T细胞计数监测病情进展。对于H IV阳性合并泌尿系统疾病需手术处理的患者,应尽可能采用微创手术治疗。同时医护人员在医疗过程中也应重视自身防护以避免职业性感染。

The Results of Surgery on HIV Carriers with Urinary System Disease

OBJECTIVE: To approach characteristics of performing operation on HIV carriers with urinary system diseases. METHODS: To summarize author's experiences of surgery on 41 HIV carriers suffering urinary system diseases abroad from April 1996 to May 2004. RESULTS: The 41 HIV carriers received HAART and were performed with corresponding operations, followed up from 4 to 30 months post-operatively. The 31 carriers have recovered well up to date, while 4 carriers died of AIDS. Among them, 2 patients with penis cancer who received a partial peotomy and a patient with renal tuberculosis receiving left nephrectomy were died of AIDS within 4-8 months after operations whose CD4+ T lymphocyte number was below 0.2 x 10(9)/L. CONCLUSION: Prior to operation, HIV carriers should receive HAART ordinarily to control copy of the virus. The CD4+ T lymphocyte number is important for selecting a proper time for operation and deciding the further after surgery. We also take note to CD4+ T lymphocyte number to monitor progress of the AIDS. For those HIV carriers, endourologic surgery and laparoscopy should be taken so far as possible. Meanwhile, medical stuffs must pay more attention to preventing occupational infection during surgery.