Dua R S, Wajed S A, Winslet M C
University Department of Surgery, The Royal Free and University College Medical School, London, UK.
Ann R Coll Surg Engl. 2007 May;89(4):354-8. doi: 10.1308/003588407X183436.
Surgical intervention has become a common component in the management of patients infected with the human immunodeficiency virus (HIV) or suffering from the clinical consequences of acquired immunodeficiency syndrome (AIDS). We investigated the evolution of this involvement at a tertiary referral centre for this condition over a 16-year period.
Detailed retrospective examination of the medical records of HIV-positive patients treated at the Royal Free Hospital between 1986 and 2002 was undertaken. Clinical, pathological and operative details of those patients who underwent surgical intervention were recorded.
Of the 2100 cases reviewed, 477 patients underwent a combined total of 772 surgical procedures. Of the 772 operations, 95 (12.3%) were performed as emergencies. Anorectal surgery represented the highest group with a total of 195 procedures (25.26%) being undertaken. The majority of patients (59%) had AIDS at the time of surgery, and 27.04% had a significant co-existing medical problem. Overall postoperative complication rate was 10.1%, with the risk being significantly greater in those undergoing intra-abdominal surgery and emergency procedures.
This is the largest study to audit the impact of HIV/AIDS in general surgical practice in the UK retrospectively. Surgery for HIV patients can be safely conducted with a low complication rate for the diagnostic and anorectal procedures that comprise the vast majority of surgery in HIV/AIDS patients. Medical treatment for patients with HIV/AIDS has developed dramatically over the last two decades. In parallel, this has resulted in a heavy, new and varied workload for general surgeons, who have also had to adapt in order to deal with the challenging spectrum of this disease.
手术干预已成为感染人类免疫缺陷病毒（HIV）或患有获得性免疫缺陷综合征（AIDS）临床后果患者管理中的常见组成部分。我们调查了一家三级转诊中心在16年期间这种情况的发展变化。
对1986年至2002年在皇家自由医院接受治疗的HIV阳性患者的病历进行了详细的回顾性检查。记录了那些接受手术干预患者的临床、病理和手术细节。
在审查的2100例病例中，477例患者共接受了772次手术。在这772例手术中，95例（12.3%）为急诊手术。肛肠手术占比最高，共进行了195例（25.26%）。大多数患者（59%）在手术时患有艾滋病，27.04%有严重的并存医疗问题。总体术后并发症发生率为10.1%，腹腔内手术和急诊手术患者的风险明显更高。
这是英国回顾性审核HIV/AIDS对普通外科实践影响的最大规模研究。对于HIV患者，诊断性手术和肛肠手术占HIV/AIDS患者手术的绝大多数，这些手术并发症发生率低，可以安全进行。在过去二十年中，HIV/AIDS患者的医疗治疗有了显著发展。与此同时，这给普通外科医生带来了繁重、全新且多样的工作量，他们也必须做出调整以应对这种疾病带来的挑战。
