Haughn Christopher, Ju Brian, Uchal Miro, Arnaud Jean Pierre, Reed James F, Bergamaschi Roberto
Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Dis Colon Rectum. 2008 Aug;51(8):1232-6. doi: 10.1007/s10350-008-9264-x. Epub 2008 May 30.
This study was performed to compare open Hartmann's reversal to laparoscopic Hartmann's reversal with regard to complication, readmission, and reoperation rates.
Data of patients who underwent open Hartmann's reversal or laparoscopic Hartmann's reversal between 1998 and 2004 at two institutions were collected. End points were complications in the hospital or after discharge, readmission to the hospital, and reoperation within 6 months after initial surgery.
Sixty-one open Hartmann's reversal and 61 laparoscopic Hartmann's reversal patients were well matched except for American Society of Anesthesiology grade (1.9 vs. 1.6; P = 0.008), timing of Hartmann's procedure (14 vs. 6 months; P = 0.001), operation time (210 vs. 154 minutes; P = 0.001), and estimated blood loss (363 vs. 254 ml; P = 0.01). Thirty-day complication rates did not differ (18 vs. 13 percent). At 6 month follow-up, open Hartmann's reversal patients had increased complication (16.4 vs. 3.3 percent; P = 0.015) and reoperation (13.1 vs. 3.3 percent; P = 0.048) rates but the same readmission rates (16.4 percent).
Compared with open Hartmann's reversal, 6 month complication and reoperation rates were lower in laparoscopic Hartmann's reversal patients. Most of the six-month complications and reoperations in open Hartmann's reversal were abdominal wall-related. Readmission rates were similar, but reasons for readmission were surgical in open Hartmann's reversal and medical in laparoscopic Hartmann's reversal.
本研究旨在比较开放Hartmann回纳术与腹腔镜Hartmann回纳术在并发症、再入院率和再次手术率方面的差异。
收集了1998年至2004年期间在两家机构接受开放Hartmann回纳术或腹腔镜Hartmann回纳术的患者数据。终点指标为住院期间或出院后的并发症、再次入院以及初次手术后6个月内的再次手术。
61例行开放Hartmann回纳术的患者和61例行腹腔镜Hartmann回纳术的患者除了美国麻醉医师协会分级（1.9对1.6；P = 0.008）、Hartmann手术时机（14对6个月；P = 0.001）、手术时间（210对154分钟；P = 0.001）和估计失血量（363对254毫升；P = 0.01）外，其他方面匹配良好。30天并发症发生率无差异（18%对13%）。在6个月随访时，开放Hartmann回纳术患者的并发症（16.4%对3.3%；P = 0.015）和再次手术率（13.1%对3.3%；P = 0.048）升高，但再入院率相同（16.4%）。
与开放Hartmann回纳术相比，腹腔镜Hartmann回纳术患者6个月时的并发症和再次手术率较低。开放Hartmann回纳术6个月时的大多数并发症和再次手术与腹壁相关。再入院率相似，但开放Hartmann回纳术的再入院原因是手术相关，而腹腔镜Hartmann回纳术是医疗相关。
