与开放手术相比，腹腔镜Hartmann逆转术具有更好的临床效果：一项涉及502例患者的国际多中心队列研究。
Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.
作者信息
Medellin Abueta Anwar, Senejoa Nairo Javier, Pedraza Ciro Mauricio, Fory Lina, Rivera Carlos Perez, Jaramillo Carlos Edmundo Martinez, Barbosa Lina Maria Mateus, Varela Heinz Orlando Ibañez, Carrera Javier A, Garcia Duperly Rafael, Sanchez Luis A, Lozada-Martinez Ivan David, Cabrera-Vargas Luis Felipe, Mendoza Andres, Cabrera Paulo, Sanchez Ussa Sebastian, Paez Cristian, Wexner Steven D, Strassmann Victor, DaSilva Giovanna, Di Saverio Salomone, Birindelli Arianna, Florez Roberto Jose Rodríguez, Kestenberg Abraham, Obando Rodallega Alexander, Robles Juan Carlos Sánchez, Carrasco Carlos Adrian Niño, Impagnatiello Alessio, Cassini Diletta, Baldazzi Gianandrea, Roscio Francesco, Liotta Gianluca, Marini Pierluigi, Gomez Daniel, Figueroa Avendaño Carlos Edgar, Villamizar Daniela Moreno, Cabrera Laura, Reyes Juan Carlos, Narvaez-Rojas Alexis
机构信息
Department of Colorectal Surgery Fundación Santa Fe de Bogotá Bogotá Colombia.
Department of Colorectal Surgery Hospital Militar Central Bogotá Colombia.
出版信息
Health Sci Rep. 2022 Sep 1;5(5):e788. doi: 10.1002/hsr2.788. eCollection 2022 Sep.
BACKGROUND
Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach.
METHODS
The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes.
RESULTS
Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission ( = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, < 0.5); mortality rate was 1%.
CONCLUSIONS
Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.
背景
哈特曼手术（HP）用于治疗结肠穿孔和结肠梗阻等外科急症。HP术中进行的“临时性”结肠造口术并不总是会被回纳，部分原因是回纳可能会带来发病和死亡风险。HP术后患者需要永久性结肠造口的因素有多种。因此，关于采用何种技术仍存在一些讨论。本研究的目的是评估采用腹腔镜和开放手术方式进行哈特曼回纳术患者的围手术期变量。
方法
这项多中心回顾性队列研究于2009年1月至2019年12月在全球14家机构开展。对接受哈特曼回纳术腹腔镜（LS）和开放（OS）手术方式的患者进行评估和比较。分析社会人口统计学、术前、术中变量及手术结果。评估的主要结局包括30天死亡率、住院时间、并发症及术后结局。
结果
纳入502例患者（LS组264例，OS组238例）。最常见的性别为男性，占53.7%；最常见的适应证为复杂性憩室病，占69.9%；85%为美国麻醉医师协会（ASA）II - III级。LS组和OS组术中并发症发生率分别为5.3%和3.4%。小肠损伤是最常见的术中损伤，占8.3%，OS组发生率高于LS组（12.2%对4.9%，P < 0.05）。LS组小肠意外损伤更常见（3%）。OS组有17.2%需要入住重症监护病房（ICU），而LS组为13.3%（P = 0.2）。最常见的术后并发症是肠梗阻（OS组12.6%，LS组9.8%，P = 0.4）。再次干预主要发生在OS组（15.5%对LS组的5.3%，P < 0.05）；死亡率为1%。
结论
腹腔镜哈特曼回纳术安全可行，与开放手术相比临床结局更佳。
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