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目的探讨合并HIV/AIDS的结核病患者外科治疗的手术适应证、手术时机及手术方式。方法回顾性分析自2007年1月至2015年1月采取手术治疗的48例合并HIV/AIDS的结核病患者的临床资料。术前CD4+T淋巴细胞计数>200个·μL-141例,100~200个·μL-16例,<100个·μL-11例(为28个·μL-1)。结果 48例患者均顺利完成手术,行结核病灶清除术30例,肺叶切除术10例,肺楔形切除术1例,脓胸纤维板剥离术3例,脓肿清除+植骨融合术2例,肾切除术1例,肠管减压并肠外置腹壁造瘘术1例。术中未出现职业暴露。围术期死亡1例,另47例术后未见伤口感染及其他部位继发感染;术后有结核感染中毒症状者3例,予短期激素治理症状消除。47例患者术后规范抗结核治疗,随访20~36个月未见原位结核病复发。结论合并HIV/AIDS结核病患者手术适应证及手术方式与普通结核病患者无差异。但应注意手术时机的选择,CD4+T淋巴细胞计数有重要参考价值,却不是唯一评价标准,个体化治疗能有效减少术后并发症。
Objective To investigate surgical indications, timing of surgery and surgical approaches for surgical treatment of tuberculosis patients with HIV / AIDS. Methods The clinical data of 48 TB patients with HIV / AIDS who underwent surgery from January 2007 to January 2015 were retrospectively analyzed. Preoperative CD4 + T lymphocyte counts> 200 · μL-141, 100-200 · μL-16, <100 · μL-11 (28 · μL-1). Results All of the 48 patients underwent surgery successfully. There were 30 cases of tuberculosis removal, 10 cases of lobectomy, 1 case of pulmonary wedge resection, 3 cases of empyema defibrillation, 2 cases of abscess removal and bone graft fusion, Surgery in 1 case, bowel decompression and external abdominal wall ostomy in 1 case. No occupational exposure during surgery. One patient died during perioperative period, and the other 47 patients had no wound infection and secondary infection in other sites. There were 3 cases of tuberculosis infection after operation, and the symptoms of short-term hormone administration were eliminated. 47 cases of postoperative standard anti-TB treatment, followed up for 20 to 36 months no recurrence of tuberculosis in situ. Conclusion There is no difference between surgical indications and surgical methods in patients with HIV / AIDS and tuberculosis. But should pay attention to the timing of surgery, CD4 T lymphocyte count has important reference value, but not the only evaluation criteria, individualized treatment can effectively reduce the postoperative complications.