Svenningsen Peter Olsen, Bulut Orhan, Jess Per
Department of Colorectal Surgery, Hillerød Hospital, Denmark.
Dan Med Bull. 2010 Jun;57(6):A4149.
A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients.
The medical records of all patients who underwent reversal of a colostomy after a primary Hartmann's procedure during the period May 2005 to December 2008 were reviewed retrospectively in a case-control study.
A total of 43 patients were included. Twenty-one had a laparoscopic and 22 an open procedure. The two groups matched with regard to age, sex, American Society of Anestheologists (ASA) score, body mass index and indication for Hartmann's operation. A significantly longer operation time was found for laparoscopic than for open surgery (median 285 versus 158 minutes, p < 0.001), but with less blood loss (median 100 versus 600 ml, p < 0.001), faster return of bowel function (median three versus four days, p < 0.01) and shorter postoperative hospitalization (median four versus six days, p < 0.01). No intraoperative complications occurred. One laparoscopic operation was converted (5%). There was no difference in postoperative complications between the two groups (10 versus 14%), and no anastomotic leaks. The total mortality was 2% as one patient died postoperatively after an open operation.
It is possible for trained laparoscopic colorectal surgeons to perform laparoscopic reversal of Hartmann's procedure as safely as in open surgery and with a faster recovery, shorter hospital stay and less blood loss despite a longer knife time. It therefore seems reasonable to offer patients a laparoscopic procedure at departments which are skilled in laparoscopic surgery and use it for standard colorectal surgery.
2005年5月至2008年12月期间，我们科室实施了从开放手术转为腹腔镜下哈特曼结肠造口术逆转术的操作。本研究的目的是调查这一改变是否对患者有益。
在一项病例对照研究中，对2005年5月至2008年12月期间所有在初次哈特曼手术后接受结肠造口术逆转的患者的病历进行了回顾性分析。
共纳入43例患者。21例行腹腔镜手术，22例行开放手术。两组在年龄、性别、美国麻醉医师协会（ASA）评分、体重指数和哈特曼手术指征方面相匹配。发现腹腔镜手术的手术时间明显长于开放手术（中位数分别为285分钟和158分钟，p<0.001），但失血量较少（中位数分别为100毫升和600毫升，p<0.001），肠功能恢复更快（中位数分别为3天和4天，p<0.01），术后住院时间更短（中位数分别为4天和6天，p<0.01）。术中无并发症发生。1例腹腔镜手术中转开腹（5%）。两组术后并发症发生率无差异（分别为10%和14%），且无吻合口漏。总死亡率为2%，1例患者在开放手术后死亡。
训练有素的腹腔镜结直肠外科医生能够像开放手术一样安全地进行腹腔镜下哈特曼手术的逆转，尽管手术时间较长，但恢复更快、住院时间更短且失血量更少。因此，在擅长腹腔镜手术并将其用于标准结直肠手术的科室，为患者提供腹腔镜手术似乎是合理的。
