急性阑尾炎合并艾滋病患者临床病理特点及其对手术方式的影响(1)
摘 要：目的 探讨艾滋病患者阑尾炎病理分型特点及与临床手术方式选择的关系。方法 将2013年3月～2018年3月在广州市第八人民医院外科住院治疗的37例急性阑尾炎合并艾滋病患者设为实验组，选取同期同科室治疗的非HIV感染阑尾炎患者50例设为对照组，比较两组病理类型、临床表现和手术方式等方面特点。结果 与非HIV感染患者相比较，艾滋病患者急性阑尾炎病理类型包括急性化脓性阑尾炎、急性坏疽性阑尾炎、结核，马尔尼菲蓝状菌病，巨细胞性病毒性肠炎；其中结核，马尔尼菲蓝状菌病，巨细胞病毒性肠炎发病率高于非HIV患者，差异有统计学意义(P<0.05)，在艾滋病患者中，导致患者腹腔镜手术中转开腹的主要病理类型包括结核、马尔尼菲蓝状菌病和急性坏疽性阑尾炎。结论 艾滋病患者急性阑尾炎病理类型包括急性化脓性阑尾炎、急性坏疽性阑尾炎、結核、马尔尼菲蓝状菌病、巨细胞病毒性肠炎；其中结核、马尔尼菲蓝状菌病和急性坏疽性阑尾炎等是艾滋病患者LA中转开腹的主要病理类型；术前建立合理的评判标准有助于减少中转开腹可能。
关键词：人类免疫缺陷病毒；阑尾切除术；腹腔镜检查；中转开腹；阑尾炎；结核；马尔尼菲蓝状菌；巨细胞病毒
, http://www.100md.com
中图分类号：R656.8；R512.91 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.014
文章编号：1006-1959(2018)20-0045-04
Abstract：Objective To investigate the pathological classification of appendicitis in AIDS patients and its relationship with clinical surgical methods.Methods 37 patients with acute appendicitis and AIDS who were hospitalized in the Eighth People's Hospital of Guangzhou from March 2013 to March 2018 were enrolled in the experimental group，50 patients with non-HIV-infected appendicitis treated with the same department were selected as the control group，and the pathological types，clinical manifestations and surgical methods were compared.Results Compared with non-HIV infected patients，the pathological types of acute appendicitis in AIDS patients included acute suppurative appendicitis，acute gangrenous appendicitis，tuberculosis，Marnifi blue blast disease，cytomegalovirus enteritis；Among them，the incidence of tuberculosis，Marnifi blue blast disease，cytomegalovirus enteritis was higher than that of non-HIV patients，the difference was statistically significant(P<0.05).Among AIDS patients，the main pathological types that lead to conversion to laparotomy in patients undergoing laparoscopic surgery include tuberculosis，Marnifi blue blast disease，and acute gangrenous appendicitis.Conclusion The pathological types of acute appendicitis in AIDS patients include acute suppurative appendicitis，acute gangrenous appendicitis，tuberculosis，Marnifi blue blast disease，and cytomegalovirus enteritis；among them，tuberculosis，Marnifi blue blast disease，and acute gangrenous appendicitis are the main pathological types of AIDS patients with LA conversion to open surgery；establishing a reasonable evaluation criteria before surgery can help reduce the possibility of conversion to open surgery.
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Key words：Human immunodeficiency virus；Appendectomy；Laparoscopy；Conversion to open surgery；Appendicitis；Tuberculosis； Marnifi blue bacterium；Cytomegalovirus
近年HIV感染已成为全球性问题，随着危险因素增多，患者人数不断增加。人体感染HIV后主要病理过程是免疫系统的损害，主要表现为CD4+T淋巴细胞绝对数量的减少，同时CD8+T淋巴细胞数量增加，CD4和CD8的比例失调，对机体造成多方面的影响。因细胞免疫功能低下而导致各种机会性感染和机会肿瘤(如结核，马尔尼菲蓝状菌病，弥漫性大B淋巴瘤，巨细胞性病毒性肠炎，内脏卡波西肉瘤等)[1]；HIV感染者并发急性阑尾炎具有发病快、进展快、病情重等特点，早期诊断、及时治疗是阑尾炎救治的关键。随着机会性感染几率上升，阑尾脓肿形成、粘连、阑尾坏疽穿孔几率也随着大大增加，这也是腹腔镜中转开腹的部分原因，本文通过对比分析急性阑尾炎合并艾滋病感染患者及非HIV感染患者阑尾切除组织病理类型、临床表现和手术方式等方面特点，为术前建立中转开腹的预警系统，避免不必要的中转开腹可减轻患者的住院时间及经济负担提供新思考。, http://www.100md.com(王蕾 苏华斌 肖冠英)
关键词：人类免疫缺陷病毒；阑尾切除术；腹腔镜检查；中转开腹；阑尾炎；结核；马尔尼菲蓝状菌；巨细胞病毒
, http://www.100md.com
中图分类号：R656.8；R512.91 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.014
文章编号：1006-1959(2018)20-0045-04
Abstract：Objective To investigate the pathological classification of appendicitis in AIDS patients and its relationship with clinical surgical methods.Methods 37 patients with acute appendicitis and AIDS who were hospitalized in the Eighth People's Hospital of Guangzhou from March 2013 to March 2018 were enrolled in the experimental group，50 patients with non-HIV-infected appendicitis treated with the same department were selected as the control group，and the pathological types，clinical manifestations and surgical methods were compared.Results Compared with non-HIV infected patients，the pathological types of acute appendicitis in AIDS patients included acute suppurative appendicitis，acute gangrenous appendicitis，tuberculosis，Marnifi blue blast disease，cytomegalovirus enteritis；Among them，the incidence of tuberculosis，Marnifi blue blast disease，cytomegalovirus enteritis was higher than that of non-HIV patients，the difference was statistically significant(P<0.05).Among AIDS patients，the main pathological types that lead to conversion to laparotomy in patients undergoing laparoscopic surgery include tuberculosis，Marnifi blue blast disease，and acute gangrenous appendicitis.Conclusion The pathological types of acute appendicitis in AIDS patients include acute suppurative appendicitis，acute gangrenous appendicitis，tuberculosis，Marnifi blue blast disease，and cytomegalovirus enteritis；among them，tuberculosis，Marnifi blue blast disease，and acute gangrenous appendicitis are the main pathological types of AIDS patients with LA conversion to open surgery；establishing a reasonable evaluation criteria before surgery can help reduce the possibility of conversion to open surgery.
, http://www.100md.com
Key words：Human immunodeficiency virus；Appendectomy；Laparoscopy；Conversion to open surgery；Appendicitis；Tuberculosis； Marnifi blue bacterium；Cytomegalovirus
近年HIV感染已成为全球性问题，随着危险因素增多，患者人数不断增加。人体感染HIV后主要病理过程是免疫系统的损害，主要表现为CD4+T淋巴细胞绝对数量的减少，同时CD8+T淋巴细胞数量增加，CD4和CD8的比例失调，对机体造成多方面的影响。因细胞免疫功能低下而导致各种机会性感染和机会肿瘤(如结核，马尔尼菲蓝状菌病，弥漫性大B淋巴瘤，巨细胞性病毒性肠炎，内脏卡波西肉瘤等)[1]；HIV感染者并发急性阑尾炎具有发病快、进展快、病情重等特点，早期诊断、及时治疗是阑尾炎救治的关键。随着机会性感染几率上升，阑尾脓肿形成、粘连、阑尾坏疽穿孔几率也随着大大增加，这也是腹腔镜中转开腹的部分原因，本文通过对比分析急性阑尾炎合并艾滋病感染患者及非HIV感染患者阑尾切除组织病理类型、临床表现和手术方式等方面特点，为术前建立中转开腹的预警系统，避免不必要的中转开腹可减轻患者的住院时间及经济负担提供新思考。, http://www.100md.com(王蕾 苏华斌 肖冠英)