Mosdell D M, Doberneck R C
Department of Surgery, Veteran's Administration Medical Center, Albuquerque, New Mexico.
Am J Surg. 1991 Dec;162(6):633-6; discussion 636-7. doi: 10.1016/0002-9610(91)90125-w.
Ostomy closure following the Hartmann procedure is perceived to be associated with higher morbidity and mortality rates than is ostomy closure following divided colostomy, loop colostomy, and divided ileostomy-colostomy so that ostomy closure after Hartmann procedure may be denied to certain patients. To test that perception, the charts of 59 patients undergoing a Hartmann procedure and 43 patients having ostomy closure after divided colostomy, loop colostomy, or divided ileostomy-colostomy were reviewed. Ostomy closure after Hartmann procedure was accomplished in 46 patients. These 46 patients (Group I) were compared with the 43 patients having ostomy closure following divided colostomy, loop colostomy and divided ileostomy-colostomy (Group II). No deaths occurred in either group. The morbidity rate was 30% for Group I and was 19% for Group II. This difference is not significant. Major complications involved wound, lung, small bowel, and colonic anastomoses. Anastomotic stricture rate was 9% for Group I and 5% for Group II. Small bowel and anastomotic complications in both groups occurred only when ostomy closure was performed after a delay of less than 6 months after ostomy construction. Stricture occurred only after end-to-end colocolostomy and coloproctostomy and did not occur after ileocolostomy or ileoproctostomy. All strictures were successfully treated by reoperation. Anastomotic leak and pelvic abscess did not occur in either group. We conclude that ostomy closure after Hartmann procedure may be more difficult and time consuming than is ostomy closure after loop colostomy, divided colostomy, or divided ileostomy-colostomy, but ostomy closure after Hartmann procedure does not have a higher morbidity rate. We advise a delay of 6 months between ostomy construction and ostomy closure and submit that all patients whose general condition permits reoperation may safely undergo ostomy closure.
与结肠造口术、袢式结肠造口术和回肠造口术-结肠造口术分开后的造口关闭相比，哈特曼手术（Hartmann procedure）后的造口关闭被认为与更高的发病率和死亡率相关，因此某些患者可能无法接受哈特曼手术后的造口关闭。为了验证这一观点，我们回顾了59例接受哈特曼手术患者以及43例在结肠造口术、袢式结肠造口术或回肠造口术-结肠造口术分开后进行造口关闭患者的病历。46例患者完成了哈特曼手术后的造口关闭。将这46例患者（第一组）与43例在结肠造口术、袢式结肠造口术和回肠造口术-结肠造口术分开后进行造口关闭的患者（第二组）进行比较。两组均无死亡病例。第一组的发病率为30%，第二组为19%。这种差异不显著。主要并发症涉及伤口、肺部、小肠和结肠吻合口。第一组的吻合口狭窄率为9%，第二组为5%。两组的小肠和吻合口并发症仅在造口术后不到6个月延迟进行造口关闭时发生。狭窄仅发生在端端结肠结肠吻合术和结肠直肠吻合术后，回肠结肠吻合术或回肠直肠吻合术后未发生。所有狭窄均通过再次手术成功治疗。两组均未发生吻合口漏和盆腔脓肿。我们得出结论，哈特曼手术后的造口关闭可能比袢式结肠造口术、结肠造口术或回肠造口术-结肠造口术分开后的造口关闭更困难、更耗时，但哈特曼手术后的造口关闭发病率并不更高。我们建议在造口术和造口关闭之间延迟6个月，并认为所有一般状况允许再次手术的患者都可以安全地进行造口关闭。
