Department of Surgical Oncology, Bursa City Hospital, Bursa, Turkey.
Department of General Surgery, Sakarya University Training and Research Hospital, Turkey.
Biomed Res Int. 2022 Jul 4;2022:7831498. doi: 10.1155/2022/7831498. eCollection 2022.
This paper investigates the risk factors preventing the reversal and nonreversal of Hartmann's procedure, as a surgical technique that has been performed in our clinic for ten years.
The study involved a ten-year Hartmann's procedure followed up at our center. The patients were divided into Hartmann reversal and nonreversal groups. Groups were examined in terms of age, gender, diagnosis, stage of malignancy, ASA score, comorbidity, perioperative morbidity-mortality, and the length of the operation.
Age ( < 0.001), ASA score ( < 0.001), stage in case of malignancy ( = 0.002), and comorbidities ( < 0.001) were significant risk factors. The ratio of patients without any comorbidities to those with one or more comorbidities was 2.63 (95% CI 1.12-6.20). Among the malignant patients, the ratio of early-stage patients to advanced-stage patients in the group with reversal of Hartmann's colostomy was 2.82 (95% CI 1.30-6.10). In addition, the ratio of older patients to younger patients in group 2 was 0.95 (95% CI 0.92-0.98). A univariate analysis revealed that younger patients, those with lower ASA scores, those without comorbidities, and those with early-stage malignancy had a greater chance of closure of the stoma.
Although Hartmann's procedure is performed in emergency surgery, the nonreversal of the colostomy is a problem in itself. It should be kept in mind that patients who have high risks are likely to have a permanent stoma.
本研究旨在探讨导致 Hartmann 手术逆转和非逆转失败的风险因素，该手术技术在我们的临床实践中已经应用了十年。
本研究回顾性分析了在我院接受 Hartmann 手术的十年间的临床资料。将患者分为 Hartmann 手术逆转组和非逆转组，比较两组患者的年龄、性别、诊断、恶性肿瘤分期、ASA 评分、合并症、围手术期发病率和死亡率以及手术时间。
年龄（<0.001）、ASA 评分（<0.001）、恶性肿瘤分期（=0.002）和合并症（<0.001）是导致 Hartmann 手术非逆转的显著风险因素。无合并症患者与合并 1 种或多种合并症患者的比例为 2.63（95%CI 1.12-6.20）。在恶性肿瘤患者中，Hartmann 结肠造口术逆转组中早期患者与晚期患者的比例为 2.82（95%CI 1.30-6.10）。此外，组 2 中年龄较大的患者与年龄较小的患者的比例为 0.95（95%CI 0.92-0.98）。单因素分析显示，年轻患者、ASA 评分较低的患者、无合并症的患者以及早期恶性肿瘤患者更有可能进行造口关闭。
虽然 Hartmann 手术是在急诊手术中进行的，但造口的非逆转本身就是一个问题。应该记住，高风险患者可能需要永久性造口。
