Mock C N, Amaral J, Visser L E
Department of Surgery, Brown University, Providence, Rhode Island 02903.
Ann Surg. 1992 Mar;215(3):244-9. doi: 10.1097/00000658-199203000-00008.
Typhoid ileal perforation remains a frequently fatal illness in the developing world. The purpose of a retrospective review of 195 cases was to ascertain prognostic indices and therapeutic options influencing outcome. The overall mortality rate of 31% was worsened by extremes of age (p less than 0.025), generalized peritonitis (p less than 0.025), lower white blood cell count (p less than 0.05), increased number of perforations (p less than 0.005), and postoperative enterocutaneous fistula (p less than 0.005). Double-layer closure of the perforation lowered the mortality rate compared with single-layer closure (p less than 0.01). Broader-spectrum antibiotics, in the form of chloramphenicol with gentamycin, metronidazole, or both, reduced the mortality rate compared with chloramphenicol alone (p less than 0.05). Based on these findings, a prospective series was initiated in which all patients were treated with two-layer closure and chloramphenicol, gentamycin, and metronidazole. The mortality rate of 8% for the 26 patients treated in this manner confirmed the improved survival with these treatment modalities. Improved survival from typhoid perforation is possible with simple, low-cost measures.
在发展中国家，伤寒性回肠穿孔仍然是一种常导致死亡的疾病。对195例病例进行回顾性研究的目的是确定影响预后的指标和治疗选择。年龄极端情况（p<0.025）、弥漫性腹膜炎（p<0.025）、白细胞计数较低（p<0.05）、穿孔数量增加（p<0.005）以及术后肠皮肤瘘（p<0.005）使总体死亡率31%进一步升高。与单层缝合相比，穿孔双层缝合降低了死亡率（p<0.01）。以氯霉素联合庆大霉素、甲硝唑或两者使用的广谱抗生素与单独使用氯霉素相比降低了死亡率（p<0.05）。基于这些发现，启动了一项前瞻性研究系列，所有患者均接受双层缝合以及氯霉素、庆大霉素和甲硝唑治疗。以这种方式治疗的26例患者死亡率为8%，证实了这些治疗方式可提高生存率。通过简单、低成本的措施有可能提高伤寒穿孔患者的生存率。
