AIDS合并神经外科疾病的手术治疗经验分析
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摘要
目的探索获得性免疫缺陷综合征(AIDS)患者合并神经外科疾病时进行手术治疗的可行性、时效性、安全性、并发症及是否影响预后的治疗经验。方法对2012年4月至2017年6月首都医科大学附属北京地坛医院收治的52例AIDS合并神经外科疾病患者的入院情况、神经外科疾病种类、手术治疗方法、术后并发症、检验结果及术后临床症状改善情况进行分析总结。结果 52例AIDS患者均接受了神经外科手术治疗,术前住院时间(5. 6±1. 2) d,术后住院时间(12. 0±1. 5) d;血CD+4细胞计数及病毒载量数值对术后并发症未见明显影响,术后并发症无明显增加;不同部位、病理类型及手术方式对AIDS患者预后不同,手术可改善AIDS合并神经外科疾病患者预后。52例患者术后无中枢神经系统感染或手术切口感染,同时未见患者其他机会性感染情况增加。术后随访12个月,52例患者中临床症状缓解(减轻或消失) 38例(73. 0%),症状持续11例(21. 1%),临床症状进展3例(5. 7%)。结论 AIDS不是神经外科疾病手术的禁忌证,及时、有效、安全、适当的手术治疗对AIDS合并神经外科疾病患者有益。
Objective To evaluate the feasibility,efficacy,safety,complications and influence on prognosis of neurosurgical procedures for neurosurgical disease in patients with acquired immunodeficiency syndrome( AIDS). Methods A total of 52 patients with neurosurgical disease and AIDS,who underwent neurosurgical procedures at Beijing Ditan Hospital Affiliated to Capital Medical University between Apr. 2012 and Jun. 2017,were enrolled in the study. The demographic data,neurological disease category,neurosurgical operation method,postoperative complications,clinical test results and postoperative symptom improvement of all patients were analyzed and summarized. Results All of the 52 patients underwent neurosurgery. The mean hospital stay before surgery( 5. 6 ± 1. 2) d,after surgery was( 12. 0 ± 1. 5) d. The count of serum CD+4 cell and viral load was not significantly associated with the incidence of adverse events. The neurosurgical operation improved the prognosis of patients with neurosurgical disease and AIDS,which would differ from different surgical sites,pathological types and operation types. No infection of central nervous system and surgical incision and opportunistic infections were observed in all patients. During the 12-month follow-up,remission,persistence and progression of clinical symptoms were observed in38 patients( 73. 0%),11 patients( 21. 1%) and 3 patients( 5. 7%),respectively. Conclusion AIDS is not the contraindication of neurosurgical treatment. Effective and safe operation provides significant benefits for patients with neurosurgical disease and AIDS.
Objective To evaluate the feasibility,efficacy,safety,complications and influence on prognosis of neurosurgical procedures for neurosurgical disease in patients with acquired immunodeficiency syndrome( AIDS). Methods A total of 52 patients with neurosurgical disease and AIDS,who underwent neurosurgical procedures at Beijing Ditan Hospital Affiliated to Capital Medical University between Apr. 2012 and Jun. 2017,were enrolled in the study. The demographic data,neurological disease category,neurosurgical operation method,postoperative complications,clinical test results and postoperative symptom improvement of all patients were analyzed and summarized. Results All of the 52 patients underwent neurosurgery. The mean hospital stay before surgery( 5. 6 ± 1. 2) d,after surgery was( 12. 0 ± 1. 5) d. The count of serum CD+4 cell and viral load was not significantly associated with the incidence of adverse events. The neurosurgical operation improved the prognosis of patients with neurosurgical disease and AIDS,which would differ from different surgical sites,pathological types and operation types. No infection of central nervous system and surgical incision and opportunistic infections were observed in all patients. During the 12-month follow-up,remission,persistence and progression of clinical symptoms were observed in38 patients( 73. 0%),11 patients( 21. 1%) and 3 patients( 5. 7%),respectively. Conclusion AIDS is not the contraindication of neurosurgical treatment. Effective and safe operation provides significant benefits for patients with neurosurgical disease and AIDS.
引文
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[8] Weill O,Finaud M,Bille F,et al. Malignant spinal cord glioma. A new complicant of hiv virus infection?[J]. Presse Med,1987,16(39):1977.
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[10] Francisci D,Giannini S,Baldelli F,et al. HIV type1infection and not short-term HAART,induces endothelial dysfunction[J].AIDS,2009,23(5):589-596.
[11] Brilla R,Nabavi DG,Schulte-Altedomeburg G,et al. Cerebral vasculopathey in HIV infection revealed by transcranial Doppler:A pilot study[J]. Stroke,1999,30(4):811-813
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[14] Dodson TB,Perrott DH,Gongloff L,et al. Human immundeficiency virus scrostatus and the risk of postextraction cimplications[J]. Int J Oral Maxillofc Surg,1994,23(2):100-103.
[15]钱南平,马超,冯秀岭,等. HIV/AIDS患者外科手术的安全性评估及职业防护[J].中国现代医生,2010,48(25):95-96.
[16]武英,张富杰,闪累华.关怀与心理支持-中国预防与控制艾滋病的重要环节[J].中国性病艾滋病防治,2002,8(4):244-246.
[17]成永达,吴磊,寸新华,等.医护人员在普外科手术中对HIV的防护[J].中国现代护理杂志,2009,33(2):78-79.
[18]刘保池,刘立,李垒,等. HIV感染者的外科治疗与医务人员职业暴露防护分析[J].中国全科医学,2010,13(4):448-449.
[19]郑刚,成永达,寸新华,等.艾滋病患者外科手术80例体会[J].昆明医学院学报,2010,31(5):146-148.
[20] Wheeler DW,Baigrie RJ. Palliative surgery for acute bowel obstuction caused by Kaposi's sarcoma in a patient with AIDS[J]. Int J Clin Pract,2003,157(4):347-348.
[21]韦永忠. HIV/AIDS合并外科疾病18例手术治疗体会[J].现代保健医学创新研究,2008,5(32):19-20.
[22] Hogan C,Wilkins E. Neurological eomplieatiom in HIV[J].ClinMed,2011,11:571-575.
[23]杨志寅,苏中华,孔令斌,等.诊疗行为的影响因素与对策[J].中国行为医学科学,2005,14(10):865-868.
[2]李太生,王爱霞,邱志峰,等.艾滋病的免疫发病机制和免疫重建[J].中华医学杂志,2001,81(5):310-313.
[3] Broder S. The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic[J]. Antiviral Res,2010,85(1):1-18.
[4]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南(2011版)[J].中华传染病杂志,2011,29(10):629-632.
[5] Gildenberg PL,Gathe JC Jr,Kim JH. Stereotactic biopsy of cerebral lesions in AIDS[J]. Clin Infect Dis,2000,30(3):491-499.
[6] Sotrel A,Dalcanto MC. HIV-1 and its casual relationship to immunosuppression and nervous system disease in AIDS:A review[J].Hum Patho,2000,31(10):1274-1298.
[7] Antinori A. Evaluation and management of intracranial mass lesions in AIDS. Quality Standards Subcommittee of the American Academy of Neurology[J]. Neurology,1998,51(4):1232-1233.
[8] Weill O,Finaud M,Bille F,et al. Malignant spinal cord glioma. A new complicant of hiv virus infection?[J]. Presse Med,1987,16(39):1977.
[9] Grossmith J,Rosenblum blL. Biopsy considerations in acquired immunodeficiency syndrome[M]//Gildenberg PL,Tasker RR,(eds):Textbook of Stereotactic and Functional Neurosurgery.New York:Mc Graw-Hill,1998:437-442.
[10] Francisci D,Giannini S,Baldelli F,et al. HIV type1infection and not short-term HAART,induces endothelial dysfunction[J].AIDS,2009,23(5):589-596.
[11] Brilla R,Nabavi DG,Schulte-Altedomeburg G,et al. Cerebral vasculopathey in HIV infection revealed by transcranial Doppler:A pilot study[J]. Stroke,1999,30(4):811-813
[12] Kuller LH,Tracy R,Belloso W,et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection[J].PLo S Med,2008,5(10):e203.
[13] Eyskens E. Ethics in actual surgery,the surgeon and HIV seropositive and AIDS patients[J]. Acts Chir Belg,1994,94(3):189.
[14] Dodson TB,Perrott DH,Gongloff L,et al. Human immundeficiency virus scrostatus and the risk of postextraction cimplications[J]. Int J Oral Maxillofc Surg,1994,23(2):100-103.
[15]钱南平,马超,冯秀岭,等. HIV/AIDS患者外科手术的安全性评估及职业防护[J].中国现代医生,2010,48(25):95-96.
[16]武英,张富杰,闪累华.关怀与心理支持-中国预防与控制艾滋病的重要环节[J].中国性病艾滋病防治,2002,8(4):244-246.
[17]成永达,吴磊,寸新华,等.医护人员在普外科手术中对HIV的防护[J].中国现代护理杂志,2009,33(2):78-79.
[18]刘保池,刘立,李垒,等. HIV感染者的外科治疗与医务人员职业暴露防护分析[J].中国全科医学,2010,13(4):448-449.
[19]郑刚,成永达,寸新华,等.艾滋病患者外科手术80例体会[J].昆明医学院学报,2010,31(5):146-148.
[20] Wheeler DW,Baigrie RJ. Palliative surgery for acute bowel obstuction caused by Kaposi's sarcoma in a patient with AIDS[J]. Int J Clin Pract,2003,157(4):347-348.
[21]韦永忠. HIV/AIDS合并外科疾病18例手术治疗体会[J].现代保健医学创新研究,2008,5(32):19-20.
[22] Hogan C,Wilkins E. Neurological eomplieatiom in HIV[J].ClinMed,2011,11:571-575.
[23]杨志寅,苏中华,孔令斌,等.诊疗行为的影响因素与对策[J].中国行为医学科学,2005,14(10):865-868.