Ameh E A, Dogo P M, Attah M M, Nmadu P T
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Br J Surg. 1997 Apr;84(4):558-9.
Typhoid fever is a public health problem in the developing world and gut perforation remains the major complication with a high associated mortality rate. Even though most surgeons agree that elimination of peritoneal soilage and endotoxaemia by surgery offers the best hope of survival, the extent of surgery remains controversial. This prospective study compared the results of three operations for this condition.
A total of 64 patients with clinical suspicion of typhoid perforation were treated by one of three operations (simple closure, wedge excision and anastomosis or segmental resection and anastomosis) at this hospital. The management protocol was the same for the three groups. The risk of reperforation, mortality rate and duration of hospital stay were compared.
The risk of reperforation and mortality rate were highest (two and 13 of 21 respectively) in patients who had wedge excision and lowest (zero and nine of 25 respectively) in those who had segmental resection. The risk of reperforation and mortality rate were zero and nine of 18 respectively in the simple closure group.
Segmental resection seems to be the best treatment for typhoid perforation and is recommended for surgeons practising in a similar environment.
伤寒热在发展中国家是一个公共卫生问题，肠穿孔仍然是主要并发症，死亡率很高。尽管大多数外科医生都认为通过手术消除腹腔污染和内毒素血症是生存的最大希望，但手术范围仍存在争议。这项前瞻性研究比较了针对这种情况的三种手术的结果。
本医院共有64例临床怀疑伤寒穿孔的患者接受了三种手术之一（单纯缝合、楔形切除并吻合或节段性切除并吻合）治疗。三组的管理方案相同。比较了再穿孔风险、死亡率和住院时间。
楔形切除患者的再穿孔风险和死亡率最高（分别为21例中的2例和13例），节段性切除患者的再穿孔风险和死亡率最低（分别为25例中的0例和9例）。单纯缝合组的再穿孔风险和死亡率分别为18例中的0例和9例。
节段性切除似乎是伤寒穿孔的最佳治疗方法，推荐在类似环境中执业的外科医生采用。
