Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Republic of Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2023 Jun 2;18(6):e0286562. doi: 10.1371/journal.pone.0286562. eCollection 2023.
Although the advantages of laparoscopic Hartmann reversal (LHR) compared to open Hartmann reversal (OHR) have been reported in the literature, the number of multicenter studies with good matching investigating this topic is rare. In the present study, we aimed to confirm the advantages of LHR in terms of short-term outcomes through propensity score matching of LHR and OHR groups, using data collected from multiple institutions.
Patients who underwent Hartmann reversal at six institutions under the Catholic Medical Center of the Catholic University of Korea between January 1, 2005, and December 31, 2021, were included. The patients were divided into the LHR and OHR groups based on the technique used. The two groups were matched using propensity score matching (1:1 ratio, logistic regression with the nearest-neighbor method). The primary outcome was postoperative ileus (POI) frequency, and secondary outcomes were time to solid diet (days) and length of stay (days).
Among 337 patients, propensity score matching was performed on 322, after excluding 15 who had undergone open conversion. Of these, 63 patients were assigned to each group through propensity score matching. There was no difference in the frequency of adhesiolysis (77.8% vs. 82.5%, p = 0.503) or the operation time. (210 (IQR 159-290) vs. 233 (IQR 160-280), p = 0.718) between the two groups. As the primary outcome, the LHR group showed significantly lower POI frequency than the OHR group. (4.8% vs. 22.2%, p = 0.0041) Regarding the secondary outcomes, the LHR group showed a shorter period to solid diet than the OHR group. The length of hospital stay was also significantly shorter in the LHR group (4 vs. 6, p < 0.0001; 9 vs. 12, p<0.0001).
LHR is an effective method to ensure faster recovery of patients after surgery compared to OHR.
尽管腹腔镜 Hartmann 反转术（LHR）与开腹 Hartmann 反转术（OHR）相比具有优势已在文献中报道，但很少有关于该主题的多中心、良好匹配的研究。在本研究中，我们旨在通过对多家机构收集的数据进行倾向评分匹配，确认 LHR 在短期结果方面的优势。
纳入 2005 年 1 月 1 日至 2021 年 12 月 31 日期间在天主教大学附属天主教医疗中心的六家机构接受 Hartmann 反转术的患者。根据所使用的技术将患者分为 LHR 和 OHR 组。使用倾向评分匹配（1:1 比例，最近邻法逻辑回归）对两组进行匹配。主要结局是术后肠梗阻（POI）的发生率，次要结局是固体饮食时间（天）和住院时间（天）。
在 337 名患者中，排除 15 名接受开腹转换的患者后，对 322 名患者进行了倾向评分匹配。通过倾向评分匹配，将 63 名患者分配到每个组。两组在粘连松解术的发生率（77.8% vs. 82.5%，p = 0.503）或手术时间方面没有差异。（210（IQR 159-290）vs. 233（IQR 160-280），p = 0.718）。作为主要结局，LHR 组的 POI 发生率明显低于 OHR 组。（4.8% vs. 22.2%，p = 0.0041）关于次要结局，LHR 组固体饮食的时间明显短于 OHR 组。LHR 组的住院时间也明显缩短（4 天 vs. 6 天，p < 0.0001；9 天 vs. 12 天，p<0.0001）。
与 OHR 相比，LHR 是一种确保患者术后更快康复的有效方法。
