Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting
Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting
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DOI：
10.1186/1749-7922-7-4
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发表时间：
2012-03-08
影响因子：
8
通讯作者：
Gilyoma, Japhet M.
中科院分区：
文献类型：
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作者：
Chalya, Phillipo L.;Mabula, Joseph B.;Gilyoma, Japhet M.
背景：伤寒肠穿孔在许多发展中国家仍然很普遍。尽管在管理方面取得了进展，但在资源有限的国家，这些患者的结局仍然很差。本研究是回顾我们的经验，伤寒肠穿孔的手术治疗，并确定在我们的本地setting.METHODS的死亡率的预后因素：这是一个回顾性和前瞻性相结合的研究，谁是伤寒肠穿孔在Bugando医疗中心2006年8月至2011年9月之间进行手术的患者。结果：共调查伤寒患者104例，占伤寒病例的8.7%。男性比女性多受影响两倍（2.6：1）。他们的年龄从8岁到76岁不等，中位年龄为18.5岁。11-20岁年龄组为发病高峰期。发热和腹痛是最常见的症状，大多数患者（80.8%）在发病后14天内穿孔。胸部和腹部X线片显示74.7%的病例发生了气胸。超声显示85.7%的病例有游离腹膜积液。9例（10.2%）患者为HIV阳性，中位CD 4+计数为261个细胞/穆尔。90例（86.5%）患者的穿孔-手术间隔超过72小时。大多数患者（84.6%）有单一穿孔，回肠是86.2%病例中最常见的受累肠部分。穿孔的简单闭合是最常进行的手术，占病例的78.8%。术后并发症发生率为39.4%，手术部位感染是最常见的并发症，占55.5%。死亡率为23.1%，与延迟就诊、入院前抗生素治疗不充分、入院时休克、HIV阳性、低CD 4计数（< 200个细胞/穆尔）、阿萨分级高（III-V）、延迟手术、多处穿孔、严重腹膜污染和术后并发症的存在有统计学意义（P < 0.001）。中位总住院时间为28 day.CONCLUSION：伤寒肠穿孔仍然是地方病，在我们的设置，并进行高发病率和死亡率。本研究试图确定在我们的环境中统计影响伤寒穿孔死亡率的因素。针对这些因素采取适当措施至关重要，以便为该地区的这些患者提供最佳护理。
BACKGROUND: Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting.METHODS: This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15.RESULTS: A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/mul. The perforation-surgery interval was more than 72 hours in 90(86.5%) patients. The majority of patients (84.6%) had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/mul), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications (P < 0.001). The median overall length of hospital stay was 28 days.CONCLUSION: Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment. Appropriate measures focusing at these factors are vital in order to deliver optimal care for these patients in this region.