Hartmann 手术及其后续肠重建的结果。哪些患者最有可能进行逆转？
Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal?
机构信息
Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain.
出版信息
Am J Surg. 2019 Nov;218(5):918-927. doi: 10.1016/j.amjsurg.2019.02.025. Epub 2019 Feb 21.
BACKGROUND
Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration.
METHODS
Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP.
RESULTS
533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction.
CONCLUSIONS
HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.
背景
本研究旨在描述 Hartmann 手术（HP）的特点和结果，以及随后的肠道重建。
方法
回顾性研究包括在连续 16 年期间接受 HP 的所有患者。我们提出了一种分类回归树，以更准确地观察与肠道重建相关的变量之间的关系及其在决定逆转 HP 中的权重。
结果
共纳入 533 例患者。HP 的总发病率为 53.5%，死亡率为 21.0%。肠连续性重建的总发病率为 47.3%，死亡率为 0.9%。良性疾病、年龄小于 69 岁且合并症低的患者，有 84.4%的概率进行肠道重建。
结论
HP 与高发病率和死亡率相关。重建肠道连续性涉及较小但频繁的发病率和较低的死亡率。年龄和合并症可以降低甚至推翻逆转 HP 的决定。
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