Gallot D, Jauffret B, Goujard F, Deslandes M, Sezeur A, Malafosse M
Service de Chirurgie Digestive, Hôpital Rothschild, Paris.
Ann Chir. 1992;46(6):491-6.
The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.
本回顾性研究的目的是明确哈特曼手术（H）的当前适应证及结果。1978年至1989年期间，共施行86例哈特曼手术，其中52例（60%）为急诊手术。适应证包括：结直肠癌（37例），其中15例为复杂性病例，22例为择期手术；急性或复杂性憩室病（24例）；缺血性结肠炎（10例）；盆腔结肠扭转（5例）；炎性肠病（4例）；结肠穿孔（3例）；乙状结肠系膜创伤性血肿（1例）。14例患者术后死亡（平均年龄：79岁）。癌症择期哈特曼手术后无死亡病例。术后并发症众多：肺部并发症（25%）、腹部伤口感染或裂开（21%）、直肠残端漏（14%），由于联合米库利奇引流，后者无害。7例患者因结肠造口坏死接受再次手术。平均首次住院时间为31天。27例患者恢复了胃肠道连续性（占存活患者的37%，憩室病患者的76%）。作者得出结论，对于复杂性憩室病，哈特曼手术可提高生存率且不影响连续性。对于癌症患者，哈特曼手术会使老年人的胃肠道永久性受损，导致低位吻合口危险，且需行姑息性腹会阴切除术。
