A Comparison between Hartmann's Procedure and Primary Anastomosis with Defunctioning Stoma in Complicated Left-Sided Colonic Perforation

目的　左側複雜性大腸破裂（包括複雜性大腸憩室炎及糞石導致大腸破裂）是會威脅病人生命的腹部急症。基於病人臨床的生命徵象及外科醫師的偏好，外科醫師可以選擇施行適當的手術來拯救病人的生命。為此，我們進行院內的病歷回顧，以比較病人在接受Hartmann術式及大腸切除併保護性腸道造廔後，兩組的差異。方法　我們總共分析了35個病人。包括比較病人的疾病種類、手術前後的資料、手術時間及總住院天數。結果　在麻醉分級、手術前後休克狀態、總手術時間、併發症及死亡率方面，都沒有統計學上的意義。但在大腸切除併保護性腸道造廔的這一組，卻有總住院時間較短及有較高的腸道造廔關閉手術比率的趨勢。結論　在緊急手術下，一旦我們把手術併發症、手術死亡率、總住院天數及腸道造廔關閉手術比率，大腸切除併保護性腸道造廔對病人的好處和Hartmann術式是相當的。

關鍵字

大腸憩室炎；大腸破裂； Hartmann術式；保護性腸道造廔

並列摘要

Purpose. Left-sided complicated colon diverticulitis or stercoral ulcer perforation is a life-threatening condition. Based on patients' condition and surgeons’ preference, surgeons can choose to perform a variety of operative methods to save patients’ lives. We perform a retrospective chart review, at our hospital, to compare patients receiving Hartmann's procedure and patients receiving primary anastomosis with defunctioning stoma. Methods. Atotal of 35 patients are analyzed. Patient demographics, perioperative data, operation time and total hospitalization days are compared. Results. No statistical difference was noted over ASAscore, shock status, total hospital stay, complication rate and mortality rate between two groups. However, there is a trend favoring the primary anastomosis with defunctioning stoma group to have shorter hospital stay and higher enterostomy takedown rate. Conclusion. Under emergency circumstances, primary anastomosis with defunctioning stoma can be an alternative choice for patients in stable condition when we take operative morbidity/mortality, total hospitalization days and enterostomy takedown rate into consideration.

並列關鍵字

Complicated colonic diverticulitis ； Stercoral ulcer perforation ； Hartmann's procedure ； Defunctioning stoma

國際替代計量

A Comparison between Hartmann's Procedure and Primary Anastomosis with Defunctioning Stoma in Complicated Left-Sided Colonic Perforation

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