[马里巴马科G点教学医院的消化道穿孔]

[Digestive tract perforations at Point G Teaching Hospital in Bamako, Mali].

作者信息

Sanogo Z Z, Camara M, Doumbia M M, Soumaré L, Koumaré S, Keïta S, Koïta A K, Ouattara M A, Togo S, Yéna S, Sangaré D

出版信息

Mali Med. 2012;27(1):19-22.

Abstract

AIMS

To determine the most frequent causes of the digestive perforations and to evaluate the surgical procedures, the morbidity and mortality.

PATIENTS AND METHODS

It was about a retrospective descriptive study, over 5 year's period in a visceral service of CHU du Point G, Bamako. Were included in the study all the patients operated for digestive perforation and hospitalized in the service of surgery "A". Were not included in the study patient operated not presenting a digestive perforation. Per operational etiologies of the perforations and their frequency were determined, as well as the morbidity and morbidity and mortality.

RESULTS

Files of 202 patients were collected. The average age of the patients was 28.3 ± 15.5 years with extremes of 6 and 71 years. The frequency of digestive perforations was higher in the age from 11 to 20 years (29.7%). The average time of consultation was of 7± 6 days. Abdominal pains, nauseas and vomiting, matter and gas stop (48.5%) were the most current functional signs. A "wood belly" abdomen was found in 72,3% of the cases. The radiography of abdomen without preparation found a diffuse greyness (64.7%), a pneumoperitoine (30.7%). A double antibiotic therapy was made in all the cases. A median laparotomy was practiced in 98,5%, and laparoscopy in 3 cases (1.5%). A single perforation was found among 172 patients (85,1%). Morbidity, all confused causes, was made of 30 cases of parietal suppurations (14.8%). Total mortality was 74%. According to aetiologies it was 10.3% in the typhic perforations, 4.6% in the appendicular perforations and 4.9% in the perforations of gastroduodenal ulcers.

CONCLUSION

The most frequent aetiologies of digestive perforation in our context were the typhoid fever, acute appendicitis and the gastroduodenal ulcer. The résection - joining and peritoneal toilet were the most practised procedure. The main factor of bad outcome remains the diagnostic delay burdening morbidity and mortality.

摘要

目的

确定消化性穿孔最常见的病因，并评估手术方式、发病率和死亡率。

患者与方法

这是一项回顾性描述性研究，为期5年，在巴马科G点大学医院的内脏科进行。纳入研究的所有患者均因消化性穿孔接受手术，并在“A”外科病房住院。未纳入研究的患者为未出现消化性穿孔的手术患者。确定穿孔的手术病因及其频率，以及发病率、发病率和死亡率。

结果

收集了202例患者的病历。患者的平均年龄为28.3±15.5岁，年龄范围为6岁至71岁。11至20岁年龄段的消化性穿孔发生率较高（29.7%）。平均就诊时间为7±6天。腹痛、恶心和呕吐、停止排气排便（48.5%）是最常见的功能体征。72.3%的病例出现“板状腹”。未做准备的腹部X线检查发现弥漫性灰度（64.7%）、气腹（30.7%）。所有病例均采用双重抗生素治疗。98.5%的患者进行了正中剖腹手术，3例（1.5%）进行了腹腔镜手术。172例患者（85.1%）发现单一穿孔。所有混杂原因导致的发病率为30例腹壁化脓（14.8%）。总死亡率为74%。根据病因，伤寒穿孔的死亡率为10.3%，阑尾穿孔为4.6%，胃十二指肠溃疡穿孔为4.9%。