Talwar S, Talwar R, Prasad P
Department of General Surgery, Jawahar Lal Nehru Medical College and Hospital, Ajmer, India.
Int J Clin Pract. 1999 Oct-Nov;53(7):514-8.
The hospital records of 58 patients operated on for tuberculous perforations of the small intestines at our hospital between 1987 and 1996 were reviewed. Clinical features were non-specific in the majority of the patients. Pneumoperitoneum on abdominal radiographs was present in only 28 (48.3%) patients. Forty-five (77.6%) were operated on within 36 hours of perforation. Surgical management consisted of resection and end-to-end anastomosis (n = 45); oval excision of the perforation and transverse anastomosis reinforced with an omental patch (n = 7); ileo-transverse colostomy (n = 5); and peritoneal drainage only (n = 1). There were 17 deaths (29.3%). Adverse prognostic factors were operation beyond 36 hours (p < 0.01), multiple perforations (p < 0.001), and faecal fistula formation (p < 0.01). Mortality was least with early resection and end-to-end anastomosis of the perforated bowel segment. We conclude that a high index of suspicion is essential for early diagnosis and optimal treatment of patients with tuberculous intestinal perforations.
回顾了我院1987年至1996年间58例因小肠结核穿孔接受手术治疗患者的医院记录。大多数患者的临床特征不具特异性。腹部X光片显示气腹的患者仅28例（48.3%）。45例（77.6%）在穿孔后36小时内接受了手术。手术方式包括切除并端端吻合（n = 45）；穿孔椭圆形切除并大网膜补片加固横行吻合（n = 7）；回肠-横结肠造口术（n = 5）；仅行腹腔引流（n = 1）。有17例死亡（29.3%）。不良预后因素包括穿孔后36小时后手术（p < 0.01）、多发穿孔（p < 0.001）和粪瘘形成（p < 0.01）。穿孔肠段早期切除并端端吻合的死亡率最低。我们得出结论，对于结核性肠穿孔患者的早期诊断和最佳治疗，高度的怀疑指数至关重要。
