胆囊切除术在获得性免疫缺陷综合征中的作用。

Flum D R, Steinberg S D, Sarkis A Y, Pacholka J R, Wallack M K

Department of Surgery, St. Vincent's Hospital and Medical Center, New York, NY, USA.

J Am Coll Surg. 1997 Mar;184(3):233-9.

BACKGROUND

Hepatobiliary disease is a common manifestation of acquired immunodeficiency syndrome, although the role of surgical intervention in the spectrum of therapy is unclear.

STUDY DESIGN

A retrospective review was designed to evaluate the characteristics of patients given a diagnosis of human immunodeficiency virus infection or acquired immunodeficiency syndrome and undergoing cholecystectomy between January 1, 1986, and November 1, 1995.

RESULTS

The study included 40 patients (35 men, 5 women; mean age, 42 +/- 9 years), 33 (82.5 percent) with acquired immunodeficiency syndrome; their mean preoperative T-helper (CD4) cell count was 163/mL3. Gross pathologic findings included acute (n = 9, 22.5 percent) and chronic (n = 31, 77.5 percent) cholecystitis. Gallbladder specimens were positive for cholelithiasis in 28 (70 percent), Cryptococcus organisms in 5 (12.5 percent), cytomegalovirus in 3 (7.5 percent), and lymphoma in 2 (5 percent). The median follow-up time was 48 months (range, 6 to 63 months). The percentage survival was 92.5 percent (n = 37) at 30 days, and 57.5 percent (n = 23), 37.5 percent (n = 15), and 25 percent (n = 10) at 12, 24, and 36 months, respectively. The mean survival time was 25.1 months. The likelihood of survival was directly linked to the CD4 cell count. The mean survival period was 25 months for patients with CD4 cell counts less than 200/mL3 compared with 48 months for those with CD4 cell counts greater than 200/mL3.

CONCLUSIONS

Although the pathologic changes identified in patients with acquired immunodeficiency syndrome may occasionally be atypical, the clinical presentation, indications for operation, and pathologic findings identified are quite common. Patients tolerate cholecystectomy well with good long-term outcome and minimal infectious complications. Even in patients with the most compromised immune status, a 2-year survival after operation is acceptable. Cholecystectomy has a clear role in the spectrum of treatment for biliary disease relative to acquired immunodeficiency syndrome.

背景

肝胆疾病是获得性免疫缺陷综合征的常见表现，尽管手术干预在治疗方案中的作用尚不清楚。

研究设计

一项回顾性研究旨在评估1986年1月1日至1995年11月1日期间被诊断为人类免疫缺陷病毒感染或获得性免疫缺陷综合征并接受胆囊切除术的患者的特征。

结果

该研究纳入40例患者（35例男性，5例女性；平均年龄42±9岁），其中33例（82.5%）患有获得性免疫缺陷综合征；他们术前的平均辅助性T（CD4）细胞计数为163/μL³。大体病理结果包括急性胆囊炎（9例，22.5%）和慢性胆囊炎（31例，77.5%）。胆囊标本中28例（70%）有胆结石，5例（12.5%）有隐球菌，3例（7.5%）有巨细胞病毒，2例（5%）有淋巴瘤。中位随访时间为48个月（范围6至63个月）。30天时的生存率为92.5%（n = 37），12、24和36个月时分别为57.5%（n = 23）、37.5%（n = 15）和25%（n = 10）。平均生存时间为25.1个月。生存可能性与CD4细胞计数直接相关。CD4细胞计数低于200/μL³的患者平均生存期为25个月，而CD4细胞计数高于200/μL³的患者为48个月。