Kassi A B, Lebeau R, Yenon K S, Katche E, Diane B, Kouassi J C
Digestive and Visceral Surgery Department, University Hospital of Cocody, Abidjan, Cote d'Ivoire.
West Afr J Med. 2011 May-Jun;30(3):169-72.
The restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity and mortality rates and low restoration rate.
To determine the causes of complications and deaths associated with Hartmann's procedure and the secondary restoration of digestive continuity for sigmoid volvulus.
This was a retrospective study involving 25 patients treated for sigmoid volvulus according to Hartmann's procedure, from January 1998 to January 2008; at the Cocody university hospital, Abidjan (Cote d'Ivoire). The mortality and morbidity rates were assessed on the basis of the age, the duration of illness, the ASA (American Society of Anesthesiologists) score, the state of the sigmoid colon and peritoneal cavity.
The mean age of the patients was 42.52 years (range: 22-77 years). The mean duration of illness was 02.80± 0.71 days (range: 06 hours to 07 days). Sixteen (64%) of the patients had an ASA score lower than III. The mean length of intervention was 209.75 min.±102.530 min. (range: 120 min. to 327 min). The mortality rate was 12% (n=3) in the Hartmann's procedure. The necrosis state of the sigmoid colon was not significantly associated with a higher death risk (p=0.071) but the contamination of the peritoneal cavity by stools (p=0.001) or an ASA score ≥3 (p=0.036) was significantly associated with a higher death risk. Infections of the operative site (42.86%) were the most common complications. The mean length of hospital stay was 12.05 ± 25.45 days. Eleven patients (50%) out of 22 had the intestinal continuity restored. The median time of restoration was 3.43 months (range: 3-12 months).The mortality rate among the restoration group was nil and the morbidity rate was 27.27% represented by parietal suppurations only. The mean length of hospital stay was 14 ± 2.83 days.
Hartmann's procedure remains associated with an significant mortality. Morbidity, essentially arises from infections of the operative site. However the restoration of the intestinal continuity remains a sure intervention with an acceptable morbidity.
哈特曼手术（Hartmann's procedure）后肠道连续性的恢复与高发病率、高死亡率以及低恢复率相关。
确定与哈特曼手术以及乙状结肠扭转消化连续性二期恢复相关的并发症和死亡原因。
这是一项回顾性研究，纳入了1998年1月至2008年1月在阿比让（科特迪瓦）科科迪大学医院按照哈特曼手术治疗的25例乙状结肠扭转患者。根据年龄、病程、美国麻醉医师协会（ASA）评分、乙状结肠和腹腔状况评估死亡率和发病率。
患者的平均年龄为42.52岁（范围：22 - 77岁）。平均病程为02.80±0.71天（范围：6小时至7天）。16例（64%）患者的ASA评分低于III级。平均手术时长为209.75分钟±102.530分钟（范围：120分钟至327分钟）。哈特曼手术的死亡率为12%（n = 3）。乙状结肠的坏死状态与较高的死亡风险无显著相关性（p = 0.071），但腹腔粪便污染（p = 0.001）或ASA评分≥3（p = 0.036）与较高的死亡风险显著相关。手术部位感染（42.86%）是最常见的并发症。平均住院时长为12.05±25.45天。22例患者中有11例（50%）恢复了肠道连续性。恢复的中位时间为3.43个月（范围：3 - 12个月）。恢复组的死亡率为零，发病率为27.27%，仅表现为腹壁脓肿。平均住院时长为14±2.83天。
哈特曼手术仍与显著的死亡率相关。发病率主要源于手术部位感染。然而，肠道连续性的恢复仍然是一种可靠的干预措施，发病率可接受。
