肠伤寒穿孔手术治疗预后的影响因素分析

目的探讨影响肠伤寒穿孔手术治疗预后的因素,为改善预后提供帮助。方法回顾性分析2010年1月至2011年12月中国援尼日尔医疗队工作点玛拉迪地方医院外科295例肠伤寒穿孔患者的临床资料。应用χ2检验和多因素Logistic回归分析影响预后的因素。结果 295例均手术治疗,病死率为20.7%(61/295)。单因素分析结果显示年龄、穿孔-手术间隔、穿孔数量和术后肠瘘与肠伤寒穿孔手术治疗的预后相关(P<0.05)。多因素Logistic回归分析显示:穿孔-手术间隔(OR=4.723,95%CI=1.403～15.897,P<0.05)、术后肠瘘(OR=3.334,95%CI=1.102～10.087,P<0.05)与肠伤寒穿孔手术治疗的预后密切相关。结论穿孔-手术间隔、术后肠瘘是肠伤寒穿孔手术治疗预后的独立影响因素。早期诊断和及时手术干预可以改善预后。

Factors Influencing Prognosis of Surgical Treatment in Typhoid Perforation

Objective To study the factors affecting prognosis in patients with typhoid ileal perforation and to offer strategies for improvement.Methods The clinical records of 295 patients who underwent surgery because of typhoid enteric perforation in the Department of Surgery,Regional Hospital of Maradi,Niger,from January 2010 to December 2011,were reviewed retrospectively.Seven of potential prognostic factors were examined by the χ2 test and the multiple Logistic regression analysis.Results The mortality rate was 20.7%(61/295).Univariate analysis revealed that age,number of perforation,perforation-operation interval(POI)and postoperative faecal fistula were significantly associated with prognosis of typhoid ileal perforation(P<0.05).Multiple Logistic regression analysis showed that perforation-operation interval(OR=4.723,95%CI=1.403-15.897,P<0.05)and postoperative faecal fistula(OR=3.334,95%CI=1.102-10.087,P<0.05)were closely associated with the prognosis.Conclusion Perforation-operation interval and postoperative faecal fistula are significant independent factors influencing prognosis of surgical treatment in typhoid perforation.Early diagnosis and timely surgical intervention could improve the prognosis.