Morandi E, Merlini D, Salvaggio A, Foschi D, Trabucchi E
I Department of Surgery, Institute of Biomedical Science L. Sacco, University of Milan, Italy.
Dis Colon Rectum. 1999 Sep;42(9):1140-4. doi: 10.1007/BF02238565.
Hemorrhoids and rectal diseases are very frequent in HIV-positive patients, especially in those with homosexual habits. This study was designed to compare posthemorrhoidectomy healing time in such patients, and evaluate the role of various factors related to their HIV-positive status.
The study involved a prospective series of 48 male patients (32 HIV-seropositive and 16 with acquired immunodeficiency syndrome) who underwent hemorrhoidectomy between 1992 and 1996; 20 age-matched and gender-matched seronegative patients were retrospectively identified as controls. Healing times, postoperative complications, and wound infections were recorded, and the delaying effect of CD4+, Karnofsky Index scores, and HIV-ribonucleic acid were evaluated. Between-group differences were analyzed using Cox's model, Student's t-test, chi-squared test, and Fisher's exact probability test. P values of <0.05 were considered statistically significant.
Cox's model revealed that HIV positivity and the presence of acquired immunodeficiency syndrome significantly delayed wound healing, which also correlated with the presence of infection. The healing rate in HIV-positive patients was 66 percent after 14 weeks and 100 percent after 32 weeks; the corresponding figures for patients with acquired immunodeficiency syndrome were 0 and 50 percent. All of the controls were healed after 14 weeks (P < 0.01 vs. both the patients with acquired immunodeficiency syndrome and HIV+ patients). Centers for Disease Control and Prevention HIV-positive status (including CD4+ counts) and the performance status proved to be of prognostic value.
Our data suggest that the indications for hemorrhoidectomy in patients with acquired immunodeficiency syndrome need to be considered extremely carefully because of the high incidence of delayed wound healing.
痔疮和直肠疾病在HIV阳性患者中非常常见，尤其是在有同性恋习惯的患者中。本研究旨在比较此类患者痔切除术后的愈合时间，并评估与他们HIV阳性状态相关的各种因素的作用。
该研究纳入了1992年至1996年间接受痔切除术的48例男性患者（32例HIV血清阳性和16例获得性免疫缺陷综合征患者）；回顾性确定20例年龄和性别匹配的血清阴性患者作为对照。记录愈合时间、术后并发症和伤口感染情况，并评估CD4 +、卡诺夫斯基指数评分和HIV核糖核酸的延迟影响。使用Cox模型、学生t检验、卡方检验和费舍尔精确概率检验分析组间差异。P值<0.05被认为具有统计学意义。
Cox模型显示，HIV阳性和获得性免疫缺陷综合征的存在显著延迟了伤口愈合，这也与感染的存在相关。HIV阳性患者在14周后的愈合率为66%，在32周后为100%；获得性免疫缺陷综合征患者的相应数字为0和50%。所有对照在14周后均愈合（与获得性免疫缺陷综合征患者和HIV阳性患者相比，P < 0.01）。疾病控制和预防中心的HIV阳性状态（包括CD4 +计数）和功能状态被证明具有预后价值。
我们的数据表明，由于伤口愈合延迟的发生率很高，对于获得性免疫缺陷综合征患者进行痔切除术的指征需要极其谨慎地考虑。
