目的

探讨手术治疗获得性免疫缺陷综合征（AIDS）合并直肠脱垂的价值，以提高临床对人类免疫缺陷病毒（HIV）感染合并直肠脱垂的认知及诊疗水平。

方法

回顾性分析2023年11月29日成都肛肠专科医院收治的1例AIDS合并Ⅲ度直肠脱垂患者的临床资料及诊疗经过。

结果

该患者因直肠脱垂入院，查体可见肛内肿物脱出肛门外，呈环状，约10 cm，可见有层次的黏膜皱襞，无法手动复位。入院后在骶管麻醉联合静脉全身麻醉下，行“经肛直肠部分切除吻合、经肛盆底重建术”，患者术后恢复原有肛门的正常外观、结构及功能。术后3 d，患者开始排便，成形、质软，且通畅。术后1周，伤口基本愈合，无明显疼痛、出血及水肿，肛门指检及肛门镜检均无异常，肛门直肠测压正常。随访1年未出现直肠脱垂复发。

结论

针对AIDS合并直肠脱垂患者，需重视早期诊断及综合评估，选择个性化手术方式是改善患者预后以及生活质量的关键。

Objective

To investigate the value of surgical treatment for patients of acquired immune deficiency syndrome （AIDS） complicated with rectal prolapse， and to improve the diagnostic and therapeutic understanding of rectal prolapse.

Methods

The clinical records， diagnosis and treatment of a patient with AIDS complicated with rectal prolapse of grade Ⅲ admitted to Chengdu Anorectal Hospital on November 29th， 2023 were reviewed， retrospectively.

Results

The patient was admitted to hospital presenting with rectal prolapse. Physical examination showed that the anal mass protruded from the anus， in a ring shape，about 10 cm and hierarchical mucosal folds could be seen， which could not be manually reduced. After admission， transanal rectal partial resection and anastomosis and transanal pelvic floor reconstruction were performed under sacral canal anesthesia plus intravenous general anesthesia. The patient's anus regained its normal appearance， structure and function after operation. Three days after the operation， the patient began to defecate， with formed， soft and unobstructed stools. One week after the operation， the wound was basically healed， with no obvious pain， bleeding or edema. Both digital rectal examination and anoscopy showed no abnormalities， and anorectal manometry was normal. There was no recurrence of rectal prolapse during the 1-year follow-up.

Conclusions

Early diagnosis and comprehensive evaluation is important for the patients with AIDS and rectal prolapse. Appropriate surgical procedure is crucial for improving the prognosis and life quality of these patients.