Butler T, Knight J, Nath S K, Speelman P, Roy S K, Azad M A
Rev Infect Dis. 1985 Mar-Apr;7(2):244-56. doi: 10.1093/clinids/7.2.244.
In Bangladesh, clinical records of 323 patients with typhoid fever were reviewed to study the incidence, fatality, and optimal therapy of the complication of intestinal perforation. Fifteen patients (4.6%) developed intestinal perforation. Case-fatality rates were six of nine patients treated medically and one of four patients treated surgically for whom the postoperative courses were known. A literature review of 57,864 cases of typhoid fever in developing countries in the antibiotic era revealed that perforation developed in 2.5% of patients, a percentage that was similar to the incidence of 2.8% reported in the preantibiotic era. The median of case-fatality rates in these reports was 43% and the proportion of all reported typhoid deaths attributable to perforation was 25%. The case-fatality rates for patients with perforation were 70% for 410 patients managed medically and 26% for 1,835 patients managed surgically. Although some reports were biased toward placing patients at lower risk into surgical treatment, the large number of patients treated successfully by surgery suggests real improvement in surgical techniques in countries with endemic typhoid fever. These results indicate that intestinal perforation persists as a major cause of death in cases of typhoid fever in developing countries in the antibiotic era and that surgical treatment with use of antibiotic therapy is optimal for this complication.
在孟加拉国，回顾了323例伤寒热患者的临床记录，以研究肠穿孔并发症的发病率、死亡率和最佳治疗方法。15例患者（4.6%）发生了肠穿孔。已知术后病程的患者中，药物治疗的9例患者中有6例死亡，手术治疗的4例患者中有1例死亡。对抗生素时代发展中国家57864例伤寒热病例的文献综述显示，2.5%的患者发生了穿孔，这一比例与抗生素时代之前报告的2.8%的发病率相似。这些报告中的病死率中位数为43%，所有报告的伤寒死亡中因穿孔所致的比例为25%。药物治疗的410例穿孔患者的病死率为70%，手术治疗的1835例患者的病死率为26%。尽管一些报告倾向于将风险较低的患者纳入手术治疗，但大量患者通过手术成功治愈，这表明在伤寒热流行的国家，手术技术有了真正的进步。这些结果表明，在抗生素时代，肠穿孔仍是发展中国家伤寒热病例的主要死亡原因，对于这种并发症，使用抗生素治疗的手术治疗是最佳选择。
