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題名 | Surgical Management of Complicated Gastrointestinal Salmonellosis in Children=小兒胃腸道沙門氏菌感染併發症之外科治療 |
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作者 | 許錦城; 張北葉; 陳秋江; 李宏昌; 黃富源; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 34:2 民82.03-04 |
頁次 | 頁84-90 |
分類號 | 417.624 |
關鍵詞 | 小兒胃腸道; 沙門氏菌感染併發症; 外科治療; |
語文 | 英文(English) |
中文摘要 | 作小兒胃腸道沙門氏菌感染需接受外科治療的病例很少,大約僅占百分之一,馬偕紀念醫院小兒外科自1984年元月至1991元10月間共經歷了11個病例;年齡從4天大到8歲大,平均年齡為l歲8個月;有64%是小於l歲,新生兒僅1例;男與女之比為8比3;最常見的致病原為乙種副傷寒沙門氏菌(73%):最常見的臨床表徵為腹痛(82%),發燒(82%)及腹肌僵直(82%)。手術的適應症包括氣腹(Pneumoperitoneum 55%),腹膜炎(36%)及腸阻塞(9%)等感染併發症;有6個病例接受一次手術,有5個病例接受分期手術(腸造瘻術);最常穿孔的器官為迴腸(54%):術後抗生素(Rocephin)治療兩個星期,全靜脈營養至少給兩個星期;手術後併發症包括腸粘連(9%),高流量腸造瘻(9%),再穿孔(9%)及傷口感染(18%);沒有手術死亡的病例:迅速診斷、早期復甦及適當的外科治療可減少沙門氏菌腸炎穿孔的死亡率。 |
英文摘要 | From January 1984 to October 1991, 11 consecutive patients with complication of Salmonella infection received surgical intervention at our hospital. The age at operation ranged from 4 days to 8 years old, with a mean of 1 year and 8 months. Most of them (64%) were under the age of one year. Eight cases were male, 3 cases were female. The most common pathogen was Salmonella paratyphi Gr. B (73%); the most common presenting symptoms and signs were abdominal pain (82%), pyrexia (82%) and muscle guarding (82%). The indications for surgery included pneumoperitoneum (55%), peritonitis (36%) and intestinal obstruction (9%); 6 cases received one stage operation, 5 cases received staged operations (enterostomy). The most commonly involved organ was ileum (54%). Ceftriazone (rocephin) was the drug of choice for the first 2 weeks postoperatively. Total parenteral nutrition (TPN) was used for at least 2 weeks. The postoperative complications included adhesion ileus (9%), high output enterostomy (9%), reperforation (9%), and wound infection (18%); there was no surgical mortality. Prompt diagnosis, early resuscitation and operative management are mandatory to avoid mortality. |
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