Fleischl William, Clifford Kari, Wright Deborah
Dunedin Hospital, Health New Zealand, Dunedin, New Zealand.
Surgical Outcomes Research Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Langenbecks Arch Surg. 2024 Dec 3;409(1):369. doi: 10.1007/s00423-024-03558-8.
Hartmann's procedure (sigmoid resection with end colostomy) is a commonly performed emergency procedure for diseases of the sigmoid colon.
To determine the proportion of patients undergoing Hartmann's reversal (restoration of GI continuity) following Hartmann's procedure, the clinical and demographic factors associated with reversal, and the reasons for non-reversal.
This is a single center, retrospective audit of patients undergoing Hartmann's procedure between June 2011 and May 2020. Age, sex, American Society of Anesthesiologists classification (ASA), indication for Hartmann's, surgical approach, specialty of responsible surgeon (General or Colorectal), 30-day reoperation, requirement for radiologically-guided drain, and reason for non-reversal were recorded. The association between these factors and reversal was determined with Fischer's exact test and logistic regression. Cumulative reversal proportions were calculated with the Kaplan-Meier method.
Data was obtained for 114/117 patients, of whom 31% (35/114) underwent Hartmann's reversal. The median (IQR) time to reversal was 372 (188-500) days. Patients with restoration of GI continuity were younger (median 67 versus 73 years, P < 0.001) with fewer co-morbidities, (ASA ≤ 2 34% versus 9% P = 0.002). The estimated cumulative 24-month reversal incidence was 37%. Patients who had a Hartmann's procedure performed for diverticulitis had an increased odds of being reversed (OR 4.1 (95% CI 1.6, 10.5) P = 0.001); Hartmann's for malignancy was associated with decreased odds of reversal (OR 0.37 (95% CI 0.12, 1) P = 0.035).
Of patients who underwent Hartmann's procedure, the majority retained a permanent stoma. Older patients, those with high ASA, and those who underwent index procedures for malignancy had lower rates of reversal.
哈特曼手术（乙状结肠切除术并端式结肠造口术）是针对乙状结肠疾病常用的急诊手术。
确定接受哈特曼手术后进行哈特曼回纳术（恢复胃肠道连续性）的患者比例、与回纳相关的临床和人口统计学因素以及未进行回纳的原因。
这是一项对2011年6月至2020年5月期间接受哈特曼手术的患者进行的单中心回顾性审计。记录患者的年龄、性别、美国麻醉医师协会分级（ASA）、哈特曼手术的指征、手术方式、负责手术的外科医生专业（普通外科或结直肠外科）、30天再次手术情况、是否需要放射引导下引流以及未进行回纳的原因。通过费舍尔精确检验和逻辑回归确定这些因素与回纳之间的关联。采用Kaplan-Meier方法计算累积回纳比例。
获取了117例患者中114例的数据，其中31%（35/114）的患者进行了哈特曼回纳术。回纳的中位（四分位间距）时间为372（188 - 500）天。恢复胃肠道连续性的患者更年轻（中位年龄67岁对73岁，P < 0.001），合并症更少（ASA≤2级为34%对9%，P = 0.002）。估计的24个月累积回纳发生率为37%。因憩室炎进行哈特曼手术的患者回纳几率增加（比值比4.1（95%置信区间1.6, 10.5），P = 0.001）；因恶性肿瘤进行哈特曼手术与回纳几率降低相关（比值比0.37（95%置信区间0.12, 1），P = 0.035）。
接受哈特曼手术的患者中，大多数保留了永久性造口。老年患者、ASA分级高的患者以及因恶性肿瘤接受初次手术的患者回纳率较低。
