Department of General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Jul;29(7):806-810. doi: 10.14744/tjtes.2023.15324.
Hartmann's procedure (HP) is commonly applied to resolve acute clinical conditions in most cases with colonic obstruction or perforation. HP and the closure of the end colostomy are associated with high morbidity-mortality rates. In our study, we aimed to report our clinical experience in HP.
Demographic data and outcomes of Hartmann procedures performed between 2015 and 2023 were retrospectively reviewed.
The median age of our study was 63 (18-94) years; 65 of the patients were female, and 97 were male. Colorectal malig-nancies were the primary etiology in 50% of patients who underwent HP, with 70% presenting with obstruction and 30% with perfora-tion. Two-thirds of the patients were American Society of Anesthesiologists-2 or higher. Postoperative complications did not develop in 74.7% of patients. Our mortality rate was 33.3%. The colostomy was closed in 59 patients during an average 2-year follow-up. The median closure time was 311 (57-1319) days. A stapler was used in 89.8% of patients during the closure. A diverting ileostomy was created in only two patients. The median hospital stay was 8 (5-70) days. Post-operative complications did not develop in 25.4% of patients, while four patients died.
In our population, HP was more commonly performed for colorectal cancer. The procedure and closure of the ostomy result in low stoma closure rates, high morbidity, and mortality rates, as well as surgical difficulties.
Hartmann 手术（HP）常用于解决大多数结直肠梗阻或穿孔引起的急性临床情况。HP 和末端结肠造口关闭与高发病率-死亡率相关。在我们的研究中，我们旨在报告我们在 HP 中的临床经验。
回顾性分析 2015 年至 2023 年间进行的 Hartmann 手术的人口统计学数据和结果。
我们研究的中位年龄为 63 岁（18-94 岁）；65 名患者为女性，97 名患者为男性。结直肠恶性肿瘤是 50%接受 HP 治疗患者的主要病因，70%的患者表现为梗阻，30%的患者表现为穿孔。三分之二的患者为美国麻醉医师学会 2 级或更高。74.7%的患者术后无并发症。我们的死亡率为 33.3%。59 例患者在平均 2 年的随访期间关闭了造口。中位关闭时间为 311（57-1319）天。89.8%的患者在关闭过程中使用吻合器。仅在两名患者中创建了转流性回肠造口。中位住院时间为 8（5-70）天。25.4%的患者术后无并发症，4 例患者死亡。
在我们的人群中，HP 更常用于结直肠癌。该手术和造口关闭导致造口关闭率低、发病率和死亡率高，以及手术难度大。
