Onen Abdurrahman, Dokucu Ali Ihsan, Ciğdem Murat Kemal, Oztürk Hayrettin, Otçu Selçuk, Yücesan Selçuk
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, Turkey.
Pediatr Surg Int. 2002 Dec;18(8):696-700. doi: 10.1007/s00383-002-0794-3. Epub 2002 Dec 20.
To determine the factors affecting morbidity in patients with typhoid intestinal perforation (TIP), 42 patients who had been operated upon for TIP between 1990 and 2000 were reviewed. The average age was 10.4 years, the male-to-female ratio 2.5/1. The mean interval from admission to operation was 6 h. Twenty-three children had multiple perforations. Primary closure (PC) was performed in 55% of the patients, ileostomy in 26%, and resection with anastomosis (RA) in 19%. Parenteral nutrition (PN) was available for 22 patients for an average of 9 days. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who received PN and in those who underwent ileostomy. None of the patients developed an enterocutaneous fistula. The 2 deaths (4.8%) resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No operative procedure is likely to be the best in all cases; therapy should be individualized. Ileostomy appears to be an effective procedure, particularly in patients with severe abdominal contamination and delayed presentation. The use of PN in addition to standard medical and surgical therapy in patients with TIP may be beneficial.
为确定影响伤寒肠穿孔(TIP)患者发病情况的因素,我们回顾了1990年至2000年间因TIP接受手术治疗的42例患者。平均年龄为10.4岁,男女比例为2.5∶1。从入院到手术的平均间隔时间为6小时。23名儿童有多处穿孔。55%的患者进行了一期缝合(PC),26%的患者进行了回肠造口术,19%的患者进行了切除吻合术(RA)。22例患者接受了肠外营养(PN),平均时间为9天。术后并发症在入院延迟和/或有严重腹膜炎的患者中更常见。接受PN的患者和接受回肠造口术的患者住院时间较短,术后并发症发生率较低。所有患者均未发生肠皮肤瘘。2例死亡(4.8%)是由严重脓毒症导致的。影响发病情况的最显著因素是穿孔至手术间隔时间延长和严重腹膜炎。在所有病例中,可能没有一种手术方法是最佳的;治疗应个体化。回肠造口术似乎是一种有效的手术方法,尤其是在腹部污染严重和就诊延迟的患者中。在TIP患者中,除了标准的内科和外科治疗外,使用PN可能有益。