近年来,由于艾滋病患者普遍接受高效抗逆转录病毒治疗,患者存活期明显延长,艾滋病合并恶性肿瘤的增加[1],需要外科手术治疗的机会增多,但艾滋病合并恶性肿瘤有其自身的特征,外科治疗也有其特殊性,医生也缺少足够的重视.复旦大学附属上海市公共卫生临床中心2009年5月至2010年11月行腹部手术治疗艾滋病合并恶性肿瘤患者12例,现报道如下。

Objective To investigate the clinical characteristic and treatment method for condyloma acuminatum with HIV Infection.Methods Retrospective analysis for 20 cases of condyloma acuminatum with HIV Infection patients(male 19 and female 1,aged 19-61 years old) was carried out.All patients had pre-operative detection of immune function.Electrocoagulation was used to remove condyloma acuminatum;the highly active antiretroviral therapy and conventional application of antibiotics to prevent infection and promptly treatment of complications.Results The patient's preoperative CD4 T lymphocyte count was 22-336 cell/μl(mean:156.84,SD:84.93),The range of preoperative CD4/CD8 was 0.056-2.014(mean:0.305,SD:0.456),far lower than general populations.There were 4 cases with great condyloma acuminatum and 2 cases were canceration.The condyloma acuminatum recrudesced in 4 within three months and 6 cases within 12 months after the operation.Conclusion The condyloma acuminatum patients with HIV infection generally had immunodeficiency and had a tendency to develop great condyloma acuminatum and canceration.The condyloma acuminatum resection by electrocoagulation combined with highly active antiretroviral therapy can get a better effect and reduce the recurrence rate.

目的 分析HIV感染者围手术期脓毒症的相关危险因素.方法 回顾性分析2008年10月至2011年9月在上海市公共卫生临床中心外科进行手术治疗的251例HIV感染患者临床资料,其中男228例,女23例.将患者分为脓毒症组和无脓毒症组两组,比较分析两组年龄、手术前后CD4、CD8、CD4/CD8、白细胞、血红蛋白、血小板、白蛋白等指标.根据手术前CD4+T淋巴细胞计数分为0～99 cells/μl (A)、100～199cells/μl(B)、200～349 cells/μl(C)、≥350 cells/μl(D)四组,比较各组围手术期脓毒症发生率,x2分割法对各组进行两两比较.进一步将HIV感染者分为年龄＜60岁组与≥60岁组两组,比较两组脓毒症发生率有无差异.结果 脓毒症组与无脓毒症组术前CD4、术后CD4、术后血红蛋白有统计学差异.术前CD4+T淋巴细胞计数无脓毒症组(290.00±194.603)显著高于脓毒症组(174.39±206.411)(P＜0.05).CD4+T淋巴细胞水平与脓毒症发生率呈显著负相关关系(r=-0.319,P =0.000).A、B、C、D四组围手术期脓毒症发生率分别为75.5％、50.9％、28.3％和19.0％,差异有统计学意义(x2 =41.609,P ＜0.05).A组与C组、A组与D组、B组与C组、B组与D组比较差异有统计学意义.HIV感染者年龄＜60岁组与≥60岁组脓毒症发生率无统计学差异.结论 CD4+T淋巴细胞计数＜200 cells/μl为HIV感染者围手术期脓毒症的高危因素,CD4+T淋巴细胞计数可作为HIV感染者围手术期脓毒症的独立预测因素.

Objective To improve the diagnosis and treatment of extensive skin degloving injury in order to reduce its disability rate and mortality.Methods Operation treatment of 15 patients with extensive skin degloving injury admitted to our department from September 1st,2009 to December 31st,2010 was retrospectively analyzed.Results 12 cases had primary healing,and 3 cases were healed after changing dressings for the wound and skin grafts.All the 15 cases recovered well.Conclusion Appropriate surgical management of extensive skin degloving injury can effectively improve the appearance and function of the skin,and can reduce its disability rate and mortality.

Background. CD4 count or CD4/CD8 ratio has been found to be a valuable marker of disease progression in HIV and AIDS. Our objective was to evaluate preoperative CD4 count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations.Methods. Retrospective analysis of 35 HIV-infected patients (four females, 31 males) undergoing abdominal operations. All patients were divided into postoperative sepsis group (A) and non-sepsis group (B). Demographic and clinical information were entered into a database and included: type of surgical procedure, age, peripheral blood cells, plasma albumin, CD4 counts, and CD4/CD8 ratios. Furthermore, we stratified and compared the incidence of postoperative sepsis according to the preoperative CD4 counts with breakpoint value of 200 cells/mu L and preoperative CD4/CD8 ratios with breakpoint value of 0.15.Results. Overall postoperative sepsis morbidity in our study was 51.43% (18/35). In sepsis group, the mean preoperative and postoperative CD4 counts, CD4/CD8 ratios, and postoperative platelet count were found significantly lower, respectively, than those in non-sepsis group (P < 0.05). The incidence of postoperative sepsis in the patients with preoperative CD4 counts <= 200 cells/mu L was markedly higher than those with CD4 counts > 200 cells/mu L (83.3% versus 17.65%; P = 0.000). Likewise, the incidence of postoperative sepsis in the patients with preoperative CD4/CD8 ratios <= 0.15 was dramatically higher than those with CD4/CD8 ratios > 0.15 (90% versus 36%; P = 0.007).Conclusions. Our preliminary study showed that HIV-infected patients with preoperative CD4 count <= 200 cells/mu L or CD4/CD8 ratio <= 0.15 had overall higher postoperative sepsis morbidity. Preoperative CD4 count or CD4/CD8 ratio may be used as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations. (C) 2012 Elsevier Inc. All rights reserved.