Joshi H M, Gosselink M P, Adusumilli S, Cunningham C, Lindsey I, Jones O M
Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Churchill Hospital, Oxford, UK,
Tech Coloproctol. 2014 Sep;18(9):843-6. doi: 10.1007/s10151-014-1144-x. Epub 2014 Mar 29.
After taking down the colostomy in a patient who has previously undergone a Hartmann's operation, it is possible to restore bowel continuity using the single-port technique via the colostomy site itself. This study presents our experience of this approach using the glove port and standard laparoscopic instrumentation. Between October 2010 and October 2013, 14 patients [median age 62 years (range 42-83 years); median body mass index 25.2 kg/m(2) (range 22.7-34.9) kg/m(2)] underwent attempted single-port (via colostomy site) reversal of Hartmann's. All but one patient had had a laparotomy for their primary surgery. The glove port was used with a camera and two working ports. Additional remote access was needed in 3 (21 %) patients [1 × 5 mm port (two patients); 2 × 5-mm ports ; 2 × 5-mm ports and Pfannenstiel]. Median operative time was 150 min (range 75-270 min). Mortality was nil. One patient required reoperation and a stoma. Median hospital stay was 5 days (range 2-36 days). Glove port reversal of Hartmann's is technically possible, though challenging if extensive adhesions are present. Outcomes are variable. Further studies will be needed to assess whether this is a safe technique.
在先前接受过哈特曼手术的患者中拆除结肠造口术后，通过结肠造口部位本身采用单孔技术恢复肠道连续性是可行的。本研究介绍了我们使用手套端口和标准腹腔镜器械采用这种方法的经验。在2010年10月至2013年10月期间，14例患者[中位年龄62岁（范围42 - 83岁）；中位体重指数25.2kg/m²（范围22.7 - 34.9）kg/m²]尝试通过单孔（经结肠造口部位）进行哈特曼手术的回纳。除1例患者外，所有患者均因初次手术接受过剖腹手术。手套端口与摄像头和两个操作端口一起使用。3例（21%）患者需要额外的远程入路[1个5mm端口（2例患者）；2个5mm端口；2个5mm端口和耻骨上横切口]。中位手术时间为150分钟（范围75 - 270分钟）。无死亡病例。1例患者需要再次手术并重新造口。中位住院时间为5天（范围2 - 36天）。哈特曼手术的手套端口回纳在技术上是可行的，不过如果存在广泛粘连则具有挑战性。结果各不相同。需要进一步研究来评估这是否是一种安全的技术。
