Consten E C, Slors F J, Noten H J, Oosting H, Danner S A, van Lanschot J J
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Dis Colon Rectum. 1995 Nov;38(11):1169-75. doi: 10.1007/BF02048332.
Anorectal disease is commonly found in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the spectrum of anorectal disease, its surgical treatment, clinical outcome, and its relation to immune status.
Medical records of all HIV-infected patients with anorectal pathology that required surgical treatment from January 1984 to January 1994 were retrospectively reviewed. Patients were divided into five different groups: common anorectal pathology (hemorrhoids, polyps, Group A); condylomata acuminata (Group B); perianal sepsis (abscesses, fistulas, Group C); anorectal ulcers (Group D); malignancies (Group E).
Eighty-three patients needed 204 surgical consultations (13 percent conservative, 87 percent operative) for 170 anorectal diseases. Fifty-one patients had multiple anorectal pathology. Operative intervention resulted in adequate wound healing and symptom relief in 59 percent of patients, adequate wound healing without relief of symptoms in 24 percent of patients, and disturbed wound healing was related to type of anorectal disease (P < 0.001) and to preoperative CD4(+)-lymphocyte counts (P < 0.01). Disturbed wound healing and most insufficient immune status were encountered in Groups C, D, and E. Within these groups low CD4(+)-lymphocyte counts were a risk factor for disturbed wound healing (P = 0.004). Median postoperative survival was highest (4.7 years) in Group A, lowest (0.6 years) in Groups D and E, and related to type of anorectal disease (P = 0.0001).
The spectrum of anorectal disease is complex. Type of anorectal disease is strongly related to immune status, wound healing, and postoperative survival.
肛门直肠疾病在人类免疫缺陷病毒（HIV）感染患者中很常见。本研究的目的是确定肛门直肠疾病的范围、其手术治疗、临床结果及其与免疫状态的关系。
回顾性分析1984年1月至1994年1月期间所有需要手术治疗的HIV感染肛门直肠疾病患者的病历。患者分为五个不同组：常见肛门直肠疾病（痔疮、息肉，A组）；尖锐湿疣（B组）；肛周脓毒症（脓肿、肛瘘，C组）；肛门直肠溃疡（D组）；恶性肿瘤（E组）。
83例患者因170种肛门直肠疾病需要进行204次手术会诊（13%为保守治疗，87%为手术治疗）。51例患者有多种肛门直肠疾病。手术干预使59%的患者伤口愈合良好且症状缓解，24%的患者伤口愈合良好但症状未缓解，伤口愈合不良与肛门直肠疾病类型（P<0.001）和术前CD4（+）淋巴细胞计数（P<0.01）有关。C组、D组和E组出现伤口愈合不良和免疫状态最差的情况。在这些组中，低CD4（+）淋巴细胞计数是伤口愈合不良的危险因素（P=0.004）。A组术后中位生存期最高（4.7年），D组和E组最低（0.6年），且与肛门直肠疾病类型有关（P=0.0001）。
肛门直肠疾病范围复杂。肛门直肠疾病类型与免疫状态、伤口愈合及术后生存期密切相关。
