Westerduin Emma, Musters Gijsbert D, van Geloven Anna A W, Westerterp Marinke, van der Harst Erwin, Bemelman Willem A, Tanis Pieter J
Department of Surgery, Tergooi Hospital, Post box 10016, 1201DA, Hilversum, The Netherlands.
Department of Surgery, Academic Medical Centre Amsterdam, Post box 22660, 1105AZ, Amsterdam, The Netherlands.
Int J Colorectal Dis. 2017 Nov;32(11):1583-1589. doi: 10.1007/s00384-017-2886-5. Epub 2017 Aug 11.
Two non-restorative options for low rectal cancer not invading the sphincter are the low Hartmann's procedure (LH) or intersphincteric proctectomy (IP). The aim of this study was to compare postoperative morbidity with emphasis on pelvic abscesses after LH and IP.
All patients that had LH or IP for low rectal cancer were included in three centres between 2008 and 2014 in this retrospective cohort study. Follow-up was performed for at least 12 months.
A total of 52 patients were included: 40 LH and 12 IP. Median follow-up was 29 months (IQR 23). There were no differences between groups in gender, age and ASA classification. Seven patients in the LH group (18%) and four patients in the IP group (33%) developed a complication within 30-day postoperative with a Clavien-Dindo classification grade III or higher (P = 0.253). Four out of 40 patients (10%) in the LH group and two out of 12 patients (17%) in the IP group developed a pelvic abscess (P = 0.612). Reinterventions were performed in 11 (28%) patients in the LH group and five (42%) patients in the IP group (P = 0.478), with a total number of reinterventions of 13 and 20, respectively. Six and 15 interventions were related to pelvic abscesses, respectively.
Pelvic abscesses seem to occur in a similar rate after both LH and IP. Previous reports from the literature suggesting that IP might be associated with less infectious pelvic complications compared to LH are not supported by this study, although numbers are small.
对于未侵犯括约肌的低位直肠癌，两种非恢复性手术选择是低位哈特曼手术（LH）或括约肌间直肠切除术（IP）。本研究的目的是比较LH和IP术后的发病率，重点关注盆腔脓肿。
本回顾性队列研究纳入了2008年至2014年间在三个中心接受LH或IP治疗低位直肠癌的所有患者。随访至少12个月。
共纳入52例患者：40例行LH，12例行IP。中位随访时间为29个月（四分位间距23个月）。两组在性别、年龄和美国麻醉医师协会（ASA）分级方面无差异。LH组7例患者（18%）和IP组4例患者（33%）在术后30天内发生了Clavien-Dindo分级为III级或更高的并发症（P = 0.253）。LH组40例患者中有4例（10%）发生盆腔脓肿，IP组12例患者中有2例（17%）发生盆腔脓肿（P = 0.612）。LH组11例（28%）患者和IP组5例（42%）患者进行了再次干预（P = 0.478），再次干预的总数分别为13次和20次。其中分别有6次和15次干预与盆腔脓肿有关。
LH和IP术后盆腔脓肿的发生率似乎相似。尽管样本量较小，但本研究不支持既往文献报道中认为IP与LH相比可能与较少的感染性盆腔并发症相关的观点。
