Takahashi-Monroy Takeshi, Velasco Liliana, Morales-Olivera José Martín
Servicio de Cirugía de Colon y Recto, Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Deleg. Tlalpan, 14000 México, D.F., México.
Cir Cir. 2006 Sep-Oct;74(5):329-33.
Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications.
In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test.
Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time.
Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.
哈特曼手术是急诊结直肠手术的一种替代方案，但其回纳术可能困难且容易出现并发症。有人建议延长回纳术的间隔时间以减少并发症。
为了确定病死亡率，并确定回纳术的时间间隔与并发症发生之间的关联，我们对48例平均年龄为57±16岁的患者进行了回顾性分析。19例患者（40%）年龄>65岁，21例患者（44%）有一种或多种基础慢性病。通过曼-惠特尼U检验和费舍尔精确检验确定与病死亡率相关的围手术期因素。
急性憩室炎是最常见的适应证（42%）。哈特曼手术与其回纳术之间的平均间隔时间为8个月（范围：1至46个月）。回纳术的平均持续时间为267分钟（范围：120至540分钟）。29例患者（60%）出现并发症，其中6例（12%）发生吻合口漏，4例（8%）手术死亡。哈特曼手术与其回纳术之间较短的间隔时间与更多并发症或更长手术时间无关。
哈特曼回纳术的发病率和死亡率较高，且不受距初次手术时间间隔的影响。
