Jain Bhupendra Kumar, Arora Himanshu, Srivastava Upendra Kumar, Mohanty Debajyoti, Garg Pankaj Kumar
University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India.
J Infect Dev Ctries. 2010 Oct 28;4(10):650-4. doi: 10.3855/jidc.829.
Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine.
A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine in a tertiary care teaching hospital in North India. The clinical profile and management of the patients were studied.
The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%.
Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.
由于小肠非创伤性穿孔会带来极高的发病率和死亡率，因此一直是外科医生需要考虑的问题。目前关于小肠非创伤性穿孔治疗的数据较少。
进行了一项回顾性研究，分析了印度北部一家三级护理教学医院收治的192例小肠非创伤性穿孔患者。对患者的临床特征和治疗方法进行了研究。
小肠非创伤性穿孔最常见的原因是伤寒（46.4%），其次是非特异性炎症（39.2%）、结核病（12.8%）和恶性肿瘤（1.6%）。一期修复是最常用的手术方式（44.0%），其次是回肠造口术（25.5%）和切除吻合术（19.3%）。浅表伤口感染是最常见的术后并发症（46.8%），其次是伤口裂开（31.3%）。皮肤切口延迟一期缝合后伤口感染率显著降低。11.5%的患者发生肠皮肤瘘/渗漏。与保守治疗相比，术后肠漏行挽救性回肠造口术的生存率更高（85.7%对50.0%）。总死亡率为16.6%。
用于治疗小肠非创伤性穿孔的手术方法可分为两类：在腹腔内留下肠缝合线的手术方法和不留下的手术方法。在患者情况不利时，不留下缝合线的手术方法似乎是更好的选择。
