CAJ | 학술논문

目的：探讨合并普外科疾病HIV/AIDS患者手术治疗的疗效及职业防护。方法本院自2011年1月至2014年1月共对91例HIV/AIDS合并普外科疾病患者实施了手术，对其临床资料和处理方法进行回顾性分析。结果91例普外科手术包括：左半肝切除术1例，胆囊切除+胆总管切开取石+T管引流术2例，腹腔镜下胆囊切除术1例；甲状腺癌根治术1例，甲状腺次全切除术2例，乳腺癌改良根治术1例；腹股沟疝修补术4例，直肠良性肿瘤切除术2例，阑尾切除术1例，乙状结肠穿孔修补+降结肠造瘘术1例，胃癌根治术1例，小肠部分切除术1例，肛瘘切除或挂线术23例，肛周脓肿切开引流术9例，混合痔切除术2例；颈部淋巴结结核病灶清除术12例，腋窝脓肿切开引流术5例，浅表淋巴结活检术16例，浅表肿物切除术6例。术后Ⅰ类切口患者未使用抗菌药物，Ⅱ、Ⅲ类切口患者使用抗菌药物预防感染或治疗。91例患者均安全度过围手术期，无1例死亡。术后伤口一期愈合45例，延期愈合46例。在所有手术中发生1例手术医生职业暴露，经过紧急局部处理和定时检测，未口服抗病毒药物，未发生HIV感染。结论 HIV/AIDS不是普外科手术的禁忌证，合理的手术治疗是挽救部分HIV/AIDS患者唯一有效的方法。医务人员应对HIV/AIDS患者实施手术应持积极态度；只要术中严格职业防护，严守操作规程，医务人员是可以避免医源性感染的。建议各大综合性医院开设感染手术室，积极收治此类患者；且能够建立完善的职业暴露处理预案和保障体系。
목적：탐토합병보외과질병HIV/AIDS환자수술치료적료효급직업방호。방법본원자2011년1월지2014년1월공대91례HIV/AIDS합병보외과질병환자실시료수술，대기림상자료화처리방법진행회고성분석。결과91례보외과수술포괄：좌반간절제술1례，담낭절제+담총관절개취석+T관인류술2례，복강경하담낭절제술1례；갑상선암근치술1례，갑상선차전절제술2례，유선암개량근치술1례；복고구산수보술4례，직장량성종류절제술2례，란미절제술1례，을상결장천공수보+강결장조루술1례，위암근치술1례，소장부분절제술1례，항루절제혹괘선술23례，항주농종절개인류술9례，혼합치절제술2례；경부림파결결핵병조청제술12례，액와농종절개인류술5례，천표림파결활검술16례，천표종물절제술6례。술후Ⅰ류절구환자미사용항균약물，Ⅱ、Ⅲ류절구환자사용항균약물예방감염혹치료。91례환자균안전도과위수술기，무1례사망。술후상구일기유합45례，연기유합46례。재소유수술중발생1례수술의생직업폭로，경과긴급국부처리화정시검측，미구복항병독약물，미발생HIV감염。결론 HIV/AIDS불시보외과수술적금기증，합리적수술치료시만구부분HIV/AIDS환자유일유효적방법。의무인원응대HIV/AIDS환자실시수술응지적겁태도；지요술중엄격직업방호，엄수조작규정，의무인원시가이피면의원성감염적。건의각대종합성의원개설감염수술실，적겁수치차류환자；차능구건립완선적직업폭로처리예안화보장체계。
Objective To investigate the effects of surgical treatment for general surgical diseases of HIV/AIDS patients and to study the occupational protection. Methods From January 2011 to January 2014, a total of 91 HIV/AIDS patients with general surgical diseases were taken kinds of operations. The clinical data were collected and analyzed, retrospectively. Results The 91 operations of general surgery include:left hemihepatectomy (1 case), cholecystectomy+choledocholithotomy+T tube drainage (2 cases), laparoscopic cholecystectomy (1 case), radical resection of thyroid cancer (1 case), subtotal thyroidectomy (1 case), modiifed radical mastectomy (1 case), injuinal hernia repair (4 cases), resection benign tumors of rectum (2 cases), appendectomy (1 case), repair of sigmoid colon perforation+descending colostomy (1 case), radical gastrectomy (1 case), partial small intestine resection (1 case), anal ifstula resection or thread-drawing (23 cases), crissum abscess drainage (9 cases), haemorrhoidectomy (2 cases), cleaning up the lesion of cervical lymph node tuberculosis (12 cases), abscess drainage of armpit (5 cases), biopsy of superifcial lymph nodes (16 cases) and resection of superifcial masses (6 cases). Antibiotic was forbidden to use for the patients with clean incision during operation, while for the patients with unclean incision, antibiotics were permitted to use to prevent or treat infection. All the 91 patients recovered safely. After operation, there were 45 patients with incision healing in the ifrst intention and 46 patients with incision delayed healing. During all the operations, there was one doctor got occupational exposure, who got local wound treatment rapidly and got test of HIV antibody regularly. The doctor did not use the drug of antivirus and did not get HIV infection. Conclusions HIV/AIDS is not the contraindication of general surgical operation. Proper operation may be the only method to cure patients with HIV/AIDS. All the medical workers should give a positive attitude to the HIV/AIDS patients that needed operations. If we get proper protection of occupation, and do as the rules strictly, the iatrogenic infection could be avoided. So the opening special operation room for infectious diseases in general hospitals were needed, in order to cope with the HIV/AIDS patients needed operations. And there will be excellent treatment for occupational exposure and security system in hospitals.