Richens J
London School of Hygiene & Tropical Medicine, UK.
Trop Doct. 1991 Oct;21(4):149-52. doi: 10.1177/004947559102100405.
The best survival rates after ileal perforation in typhoid fever are to be found in patients undergoing operation within 24 h. Conservative management of typhoid perforation, which was widely advocated after the introduction of chloramphenicol, appears to be associated with a substantially increased mortality compared to surgery, although randomized comparisons have never been conducted. Clinical, radiological and ultrasound examination assist in the diagnosis of perforation. After vigorous resuscitation, simple surgical closure of the perforation and abdominal irrigation will suffice for most cases. Antibiotics effective against S. typhi, coliforms and anaerobes are required.
伤寒热回肠穿孔后最佳生存率见于在24小时内接受手术的患者。在氯霉素引入后广泛提倡的伤寒穿孔保守治疗，与手术相比，死亡率似乎大幅增加，尽管从未进行过随机对照比较。临床、放射学和超声检查有助于穿孔的诊断。在积极复苏后，大多数病例简单的穿孔手术闭合和腹腔冲洗就足够了。需要使用对伤寒杆菌、大肠菌和厌氧菌有效的抗生素。
