接受抗逆转录病毒治疗的HIV阳性患者行腹腔镜胆囊切除术的围术期安全性分析  

Perioperative safety of laparoscopic cholecystectomy in HIV-positive patients receiving antiretroviral therapy

作　　者：李靖飞 束越 季鹏 姜坤元 尹大龙 Li Jingfei;Shu Yue;Ji Peng;Jiang Kunyuan;Yin Dalong(Department of General Surgery,Provincial Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院普通外科,合肥230001

出　　处：《国际外科学杂志》2024年第8期516-522,共7页International Journal of Surgery

摘　　要：目的探讨接受抗逆转录病毒治疗的人类免疫缺陷病毒(HIV)阳性患者行腹腔镜胆囊切除术的围术期安全性。方法采用回顾性队列研究方法,收集2020年1月一2023年12月安徽医科大学附属省立医院普通外科同一治疗组收治388例胆囊结石患者的临床资料,其中男性135例,女性253例,根据是否合并HIV感染将其分为HIV阳性组(n=25)和HIV阴性组(n=363)。收集两组患者临床病理资料和术中、术后相关数据,采用倾向性评分匹配的方法控制混杂偏倚,并对两组的麻醉方法、术中出血量、手术时长、有无中转开腹、术后并发症、术后引流量、术后住院日、治疗总费用等相关数据进行比较。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验;非正态分布的计量资料采用M(Q1,Q3)表示,组间比较采用秩和检验。计数资料使用Fisher确切概率法或使用x²检验比较。结果两组一般资料在性别、术前红细胞、中性粒细胞、谷丙转氨酶、间接胆红素方面差异有统计学意义(P<0.05)。倾向性评分匹配后,共59例配对成功,HIV阳性组25例,HIV阴性组34例,两组在一般资料比较上差异均无统计学意义(P>0.05)。匹配后,两组患者在麻醉方法、术中出血量、手术时长、有无中转开腹、术后并发症发生率,术后引流量及术后住院天数等指标上差异无统计学意义(P>0.05);HIV阳性组住院总天数、治疗总费用分别为5.0(3.0,7.0)d;(14829.3±4852.8)元,HIV阴性组分别为3.0(2.0,4.8)d;(10762.3±1850.3)元,HIV阳性组明显高于HIV阴性组,差异有统计学意义(P<0.05)。HIV阳性组围术期没有医护人员发生职业暴露。结论对于接受抗逆转录病毒治疗的HIV阳性患者,腹腔镜胆囊切除术是安全可行的。医护人员严格遵守标准化防护规程,可以降低职业暴露风险。Objective To examine the perioperative safety of laparoscopic cholecystectomy in human immunodeficiency virus(HIV)-positive patients undergoing antiretroviral therapy.Methods sAretrospective cohort study method was employed to collect clinical data from 388 patients with gallstones who were admitted to Department of General Surgery of the Provincial Hospital of Anhui Medical University between January 2020 and December 2023.The cohort comprised 135 males and 253 females.For the purpose of analysis,the participants were divided into HIV-positive group(n=25)and HIV-negative group(n=363).The distinction between the two groups was based on whether the participants were co-infected with HIV.The clinical and pathological data pertaining to the two groups of patients,along with the intraoperative and postoperative data,were collated.The propensity score matching method was employed to control for confounding bias,and the data on anaesthesia methods,intraoperative blood loss,duration of surgery,necessity for conversion to laparotomy,postoperative complications,postoperative drainage volume,postoperative hospital stay,and total treatment costs were compared between the two groups.Measurement data with normal distribution were expressed as mean±standard deviation(x±s)and compared using the t-test.Measurement data with skewed distribution were expressed as M(Qi,Qs)and compared using the rank-sum test.The Fisher exact probability method or the chi-square test was employed for the comparison of count data.Results The two groups of general data were found to be statistically significant in terms of gender,preoperative red blood cells,neutrophils,alanine aminotransferase,and indirect bilirubin exhibited statistically significant differences(P<0.05).Following propensity score matching,a total of 59 cases were identified.Of these,25 cases were observed in the HIV-positive group,while 34 cases were observed in the HIV-negative group.No statistically significant differences were observed between the two groups with respect to the

关 键 词：胆囊切除术 腹腔镜 HIV 抗逆转录病毒药 职业暴露 倾向性评分匹配 

分 类 号：R657.4[医药卫生—外科学] R512.91[医药卫生—临床医学]