장티브스 장염의 외과적 고찰

Abstract

[한글]

1970년 1월부터 1977년 12월까지 만 8년간 연세대학교 의과대학부속 세브란스병원서 수술치료한 40례의 천공성, 11례의 출혈성 장티브스에 관한 임상분석 결과 병력, 이학적소견이 진단에 가장 중요하였으며 균배양검사보다 widal test가 더욱 의의있었다.

천공부위는 대부분 회맹부 판막으로부터 50㎝ 이내에 위치하였고 원형 및 타원형으로 anti-mesenteric border에 위치하였으며 천공구의 크기도 대게 직경 1㎝이내였다.

출혈성 장티브스의 경우 수혈과 내과적 처치로 호전되지 않을 경우 가능한한 조기개복으로 사망률을 감소시킬 수 있었다.

수술술식은 가능한한 회장구역절제 및 회장단단문합술을 시행하는 것이 좋았으며 회맹부판막의 보존이 불가능한 경우 상행결장절제술을 시행하며 상태가 불량하고 주위의 염증침습이 심하지 않은 단일친공의 경우 단순봉합술을 시행하는 것도 좋은 결과를 얻었다.

사망률은 11.8%로서 대게 sepsis가 원인이었다.

[영문]

Typhoid fever, caused by Salmonella typhosa, is a world wide disease except tropical areas. Although the disease was almostly eradicated in the developed countries by the use of sanatoriun, ideal medical system, proper antibiotics, etc, but unfortunately it is not decreasing still in this country. Moreover it can cause

complications of about 10 _ 20% of intestinal bleeding and 1 _ 2% of intestinal perforation which need surgical management.

During the past 8 years from Jan. 1970 to Dec. 1977, 40 cases of perforated typhoid enteritis and 11 cases of bleeding typhoid enteritis were admitted or transferred to the Department of Surgery,. Severance Hospital, Medical School of Yonsei University.

The annual incidence of the complicated typhoid enteritis was rather decreasing slightly during last 8 years and man was more susceptible that woman about 2.2 times.

The disease was most prevalent in the young adult age group, from late teens to thirties.

The interval from the onset of the disease to the bleeding or perforation was most prominent between 1 and 2 weeks with more valid interval than previously.

Before perforation leukocyte count was normal or decreased in most cases but if perforated, leukocyte count was increased in 45% of cases.

Serologically widal test was significant in 40% of the cases but it was not absolute indicator of the diagnosis of the typhoid fever.

Blood culture was positive in 47% of cases, mostly within 2 weeks, and the stool culture was positive in 25% of cases, mostly in late 3-4 weeks.

The operation was performed as soon as possible, average in 3.2 days in bleeding cases and 2.4 days in perforated cases.

The perforation site and ulcers were located mostly within 50㎝ proximal to the ileocecal valve and the size of the perforation was small, lesser than 0.5㎝ in diameter, in most cases.

The management of the complicated typhoid enteritis was variable by the status of the patiedt, location and degree of the inflammation, bleeding or perforation, etc.

But if possible segmental resection of the ileum including the diseased bowel and end to end anastcmosis with the preservation of the ileocecal valve was most most preferable.

Complications were developed in 33.3% of the cases and most of it was due to inflammation.

Mortality was 11.8 % of the cases which were due to late discovery of the complication or late admission to the hospital, so the sepsis was the leading cause of death.