Aso Kenta, Ito Kyoji, Takemura Nobuyuki, Tsukada Kunihisa, Inagaki Fuyuki, Mihara Fuminori, Oka Shinichi, Kokudo Norihiro
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
Glob Health Med. 2022 Dec 31;4(6):309-314. doi: 10.35772/ghm.2022.01051.
The number of the human immunodeficiency virus (HIV)-positive patients are increasing worldwide, and more HIV-positive patients are undergoing urgent or elective cholecystectomy. There is still insufficient evidence on the relationship between surgical complications of cholecystectomy and antiviral status in HIV-positive patients. The purpose of the present study is to evaluate surgical outcomes after cholecystectomy in HIV-positive patients. Records of consecutive HIV-positive patients who underwent cholecystectomy between January 2010 and December 2020 were reviewed retrospectively. Patients were divided into urgent and elective surgery groups. Urgent surgery was defined as surgery within 48 hours of admission. Postoperative complications were evaluated according to the Clavien-Dindo classification. A total of 30 HIV-positive patients underwent urgent ( = 7) or elective ( = 23) cholecystectomy. Four complications (13.3%) occurred, and the rate was significantly higher in the urgent group than in the elective group ( = 0.008). However, all complications were minor (3 cases of grade I and one case of grade II), and there were no severe postoperative complications. There was no significant difference in CD4+ lymphocyte status in all patients and between the 2 groups before and after surgery ( = 0.133). No cases of postoperative deterioration in the control of HIV infection were observed. In conclusion, cholecystectomy in HIV-positive patients with controlled HIV under recent antiretroviral therapy may be performed safely even in an emergency situation.
全球范围内,人类免疫缺陷病毒(HIV)阳性患者的数量正在增加,越来越多的HIV阳性患者正在接受急诊或择期胆囊切除术。关于HIV阳性患者胆囊切除术的手术并发症与抗病毒状态之间的关系,目前仍缺乏足够的证据。本研究的目的是评估HIV阳性患者胆囊切除术后的手术结果。回顾性分析了2010年1月至2020年12月期间连续接受胆囊切除术的HIV阳性患者的记录。患者分为急诊手术组和择期手术组。急诊手术定义为入院后48小时内进行的手术。根据Clavien-Dindo分类法评估术后并发症。共有30例HIV阳性患者接受了急诊(n = 7)或择期(n = 23)胆囊切除术。发生了4例并发症(13.3%),急诊组的发生率显著高于择期组(P = 0.008)。然而,所有并发症均为轻度(I级3例,II级1例),术后无严重并发症。所有患者以及两组患者手术前后的CD4+淋巴细胞状态均无显著差异(P = 0.133)。未观察到HIV感染控制术后恶化的病例。总之,在近期抗逆转录病毒治疗下HIV得到控制的HIV阳性患者,即使在紧急情况下进行胆囊切除术也可能是安全的。