Tøttrup Anders, Frost Lise
Department of Surgery L, University Hospital of Aarhus, Tage Hansensgade 2, 8000 Aarhus C, Denmark.
Dis Colon Rectum. 2005 Feb;48(2):251-5. doi: 10.1007/s10350-004-0767-9.
An extended Hartmann's procedure is occasionally useful in rectal resections, because anastomotic, perineal, and functional problems are eliminated. This study was designed to examine the occurrence of pelvic sepsis after this procedure and identify possible risk factors.
Medical records were available for 163 patients (89 females) undergoing rectal resection with colostomy and closure of the rectal remnant. Information about pelvic sepsis and possible risk factors was obtained by review of the medical records.
Pelvis sepsis developed in 31 of 163 patients (18.6 percent). When the rectum had been transected <2 cm above the pelvic floor, 24 of 73 patients (32.9 percent) developed an abscess in contrast to 7 of 90 (7.8 percent) after higher transsection (P = 0.0001). Other risk factors were male gender and missing foot pulses. Only 61 percent of pelvic abscesses healed after a median of 59 days, leaving 39 percent unhealed after an observation period of 277 (range, 20-1,643) days.
Surgical alternatives should be considered to an extended Hartmann's procedure when the level of transsection is <2 cm above the pelvic floor, particularly in males.
扩大的哈特曼手术在直肠切除术中偶尔有用，因为它消除了吻合口、会阴和功能方面的问题。本研究旨在检查该手术后盆腔感染的发生率并确定可能的危险因素。
有163例（89例女性）接受直肠切除、结肠造口术并封闭直肠残端患者的病历资料。通过查阅病历获取有关盆腔感染和可能危险因素的信息。
163例患者中有31例（18.6%）发生盆腔感染。当直肠在盆底上方<2 cm处横断时，73例患者中有24例（32.9%）发生脓肿，而在较高平面横断后90例中有7例（7.8%）发生脓肿（P = 0.0001）。其他危险因素为男性和足部脉搏消失。盆腔脓肿中位59天后只有61%愈合，在277天（范围20 - 1643天）的观察期后仍有39%未愈合。
当横断平面在盆底上方<2 cm时，特别是男性患者，应考虑采用手术替代方案而非扩大的哈特曼手术。
