Wetterhall Carmela, Mariusdottir Elin, Hall Claire, Jörgren Fredrik, Buchwald Pamela
Colorectal Unit, Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
Department of General Surgery, Stepping Hill Hospital, Stockport, United Kingdom.
Gastrointest Tumors. 2019 Feb;5(3-4):77-81. doi: 10.1159/000493526. Epub 2018 Nov 5.
Hartmann's procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann's procedure and identify possible risk factors.
All patients who underwent Hartmann's procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records.
172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy ( = 0.03) and Hinchey grade III and IV ( = 0.02) in those patients who underwent Hartmann's procedure for diverticular disease.
Hartmann's procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.
当一期吻合术禁忌时，哈特曼手术是结直肠手术中一种成熟的替代方法。然而，直肠残端可能会引起并发症。本研究旨在调查哈特曼手术后盆腔感染的发生率，并确定可能的危险因素。
通过医院登记系统识别出2005年至2012年间接受哈特曼手术的所有患者。通过查阅病历获得有关盆腔感染以及潜在的术前、术中和术后危险因素的信息。
共识别出172例患者（97例女性）；他们的年龄为74±11岁。手术因癌症（49%）、憩室炎（35%）和其他良性疾病（16%）而进行。直肠切断在盆底和岬之间的任何位置进行。6.4%（11/172）的患者发生了盆腔感染。对于因憩室病接受哈特曼手术的患者，盆腔感染与术前放疗（P = 0.03）以及欣奇分级III级和IV级（P = 0.02）相关。
由于盆腔感染的发生率较低，当吻合术禁忌时，哈特曼手术是一种安全的手术。术前放疗以及欣奇分级III级和IV级可能是盆腔感染发生的危险因素。
