Typhoid intestinal perforations: Twenty-six year experience
Typhoid intestinal perforations: Twenty-six year experience
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DOI：
10.1007/s00268-007-9141-0
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发表时间：
2007-09-01
影响因子：
2.6
通讯作者：
Yildirgan, M. Ilhan
中科院分区：
文献类型：
--
作者：
Atamanalp, S. Selcuk;Aydinli, Bulent;Yildirgan, M. Ilhan
伤寒是一种由伤寒沙门氏菌引起的严重发热性疾病。TF最致命的并发症之一是回肠穿孔（TIP）。虽然与TIP相关的死亡率在过去十年中略有下降，但仍然很高。方法与结果对82例经手术治疗的TIP患者的临床资料进行回顾性分析。男性64例，平均年龄36.3岁（范围7-68岁）。在手术治疗中，32例（39.0%）患者行清创一期闭合术，9例（11.0%）患者行楔形切除一期闭合术。0%)，一期吻合切除9例（11.0%），回肠造口切除32例（39.0%）。术后最常见的并发症是伤口感染，共24例（29.3%）。总发病率以回肠造口组最高。总死亡率为11.0%（9例）。年龄、性别、穿孔数量和位置（p < 0.05）对死亡率没有影响，但术前时间延长（p < 0.001）、腹膜污染扩大（p < 0.01）和回肠造口手术（p < 0.001）对死亡率的增加有影响。结论早期、适当的手术干预和有效的术前、术后护理可提高TIP患者的生存率。
Background Typhoid fever (TF) is a severe febrile illness caused by Salmonella typhi. One of the most lethal complications of TF is ileal perforation (TIP). Although the mortality of associated with TIP has decreased slightly over the past decade, it is still high.Methods and Results The records of the 82 surgically treated patients with TIP were evaluated retrospectively. There were 64 men with the mean age of 36.3 years (range: 7-68 years). In surgical treatment, debridement with primary closure was performed in 32 patients (39.0%), and wedge resection with primary closure was performed in 9 (11. 0%), resection with primary anastomosis in 9 (11.0%), and resection with ileostomy in 32 (39.0%). The most common postoperative complication was wound infection, which occurred in 24 patients (29.3%). The overall morbidity was highest in the ileostomy group. The overall mortality was 11.0% (9 patients). Age, gender, number, and localization of the perforations (p > 0.05) were not found to affect mortality, but prolonged preoperative period (p < 0.001), extended peritoneal contamination (p < 0.01), and ileostomy procedure (p < 0.001) were found to influence the increase in mortality.Conclusions Early and appropriate surgical intervention with effective preoperative and postoperative care may improve survival in TIP.