Laparoscopically Assisted Reversal of Hartmann's Pouch

腹腔鏡手術關閉Hartmann's造口

浦大維(Ta-Wei Pu) ； 糠榮誠(Jung-Cheng Kang) ； 吳昌杰(Chang-Chieh Wu) ； 饒樹文(Shu-Wen Jao) ； 李家政(Chia-Cheng Lee) ； 李才宇(Tsai-Yu Lee) ； 蕭正文(Cheng-Wen Hsiao) ； 牟致遠(Chih-Yuan Mo) ； 傅軍毓(Chun-Yu Fu) ； 楊千毅(Chien-Yi Young) ； 廖啟揚(Chi-Yang Liao) ； 林昭治(Chao-Chih Lin)

《中華民國大腸直腸外科醫學會雜誌》 25卷4期 (2014/12) Pp. 122-126

https://doi.org/10.6312/SCRSTW.2014.25(4).10301

摘要

目的　腹腔鏡手術關閉Hartmann's造口是一個可以重建大腸連續性的大型手術，且通常對於老年人及身體狀況欠佳的病人有相當高的併發症與死亡率。這項回顧性研究的目的是對於腹腔鏡手術關閉Hartmann's造口的病例做綜合討論。方法　這項回顧性研究，共蒐集了九位男性和一位女性，全部都因左側大腸憩室炎破裂而接受剖腹及Hartmann's造口手術，而於2002年一月到2005年一月接受腹腔鏡手術關閉Hartmann's造口。結果　十位病人的平均年齡是58.6歲，距離因憩室炎破裂而行的剖腹手術平均5.2個月。平均手術時間是248.4分鐘，平均最長傷口為5.3公分，術中平均出血量為98.7毫升。在腹腔鏡術中沒有任何一例轉換為剖腹手術，腹腔鏡術中併發症共兩例，一例為大腸損傷，另一例為膀胱損傷。術後併發症共四例，皆為術後原Hartmann's造口處的傷口感染。術後並沒有死亡發生。結論　利用腹腔鏡手術關閉Hartmann's造口需要較高的技術及較長手術時間，但會帶來較低的致病率與死亡率。傳統剖腹是一個關閉Hartmann's造口的選擇，腹腔鏡手術關閉Hartmann's造口是另一個好選擇。目前我們傾向選擇使用腹腔鏡關閉Hartmann's造口。

關鍵字

關閉Hartmann's造口 ； 腹腔鏡 ； 憩室炎

並列摘要

Purpose. Restoration of bowel continuity after Hartmann's procedure is a major operation and is associated with increased morbidity and mortality, especially in elderly patients and in those in a poor condition. Our aim was to evaluate laparoscopically assisted reversal of Hartmann's pouch in a case series of patients. Methods. Aretrospective review of patients who underwent laparoscopically assisted reversal of Hartmann's pouch was performed between January 2002 and January 2005. All 10 patients were diagnosed with perforated diverticulitis of left sided colon and were initially treated by exploratory laparotomy with Hartmann's procedure. Results. Ten patients (9 men and 1 woman; mean age, 58.6 years) underwent laparoscopically assisted reversal of Hartmann's pouch. All patients were diagnosed with perforated diverticulitis at a mean time of 5.2 months after the initial operation. The mean operative time was 248.4 min, and the mean longest incision length was 5.3 cm. The mean estimated blood loss was 98.7 ml. No conversion to laparotomy was noted (0%). Intraoperative complications included 1 bowel injury and 1 bladder injury. Post-operative complications included 4 colostomy-site wound infections. There was no mortality associated with the procedure. Conclusions. Laparoscopically assisted reversal of Hartmann's pouch is technically challenging and time consuming. It has low operative morbidity and mortality. Conventional laparotomy is one choice for reversal of Hartmann's pouch, and laparoscopic reversal of Hartmann's pouch is another good choice. Laparoscopic reversal is our preferred approach for reversal of Hartmann's pouch.

並列關鍵字

Reversal of Hartmann's pouch ； Laparoscopy ； Diverticulitis

參考文獻

1 Khaikin M, Zmora O, Rosin D, Bar-Zakai B, Goldes Y, Shabtai M, et al. Laparoscopically assisted reversal of Hartmann's procedure. Surg Endosc 2006;20:1883-6.

4 Vermeulen, J, Coene PP, Van Hout NM, van der Harst E, Gosselink MP, Mannaerts GH, et al. Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann's procedure be considered a one-stage procedure? Colorectal Dis 2009;11:619-24.

5 van de Wall BJ, Draaisma WA, Schouten ES, Broeders IA, Consten EC. Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. J Gastroint Surg 2010;14:743-52.

6 Banerjee S, Leather AJ, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S. Feasibility and morbidity of reversal of Hartmann's. Colorectal Dis 2005;7:454-9.

8 Lucarini L, Galleano R, Lombezzi R, Ippoliti, M, Ajraldi G. Laparoscopic-assisted Hartmann's reversal with the Dexterity Pneumo Sleeve. Dis Colon Rectum 2000;43:1164-7.