- 期刊
A Comparison between Hartmann's Procedure, Primary Anastomosis, and Primary Anastomosis with Defunctioning Stoma in Hinchey III and IV Diverticulitis
比較Hartmann術式、初次吻合和併保護性腸道造廔之初次吻合在Hinchey III期和IV期憩室炎的情況
摘要
Purpose. Complicated perforated colon diverticulitis (Hinchey stages III and IV) is an emergent condition that requires an operation, such as Hartmann's procedure or primary anastomosis, with or without a defunctioning stoma. Mortality, postoperative complications, and ostomy takedown rates remain debatable among these three groups. This retrospective study aimed to compare patients who underwent Hartmann's procedure in our hospital with those who underwent primary anastomosis, with or without a dysfunctioning stoma. Methods. This study analyzed 26 patients, categorizing them into Hartmann's procedure and primary anastomosis groups with and without a de-functioning stoma. Patient mortality rate, postoperative complication rate, operation time, hospital stay, and surgical reintervention rates were compared. Results. Lesion location, American Society of Anesthesiologist score, peri-operative shock status, blood loss, intensive care unit stay time, complication rate, and mortality rate were not statistically different between the three groups. However, the Hartmann's procedure group demonstrated a statistical difference with greater age, fecal peritonitis rate, and Hinchey stage IV rates, and lower ostomy takedown rate but the least operation time. The primary anastomosis without a defunctioning stoma group demonstrated shorter hospital stays. Selection bias may have influenced these results. Conclusion. Hartmann's procedure remained crucial for unstable patients with acute complicated perforated colonic diverticulitis, particularly those at high risk of colostomy reversal failure. Our statistical analysis revealed that primary anastomosis, with or without stoma, could serve as a variable alternative option, provided the patient's condition remains stable during emergency surgery. This approach demonstrated non-inferior operative morbidity/mortality rate and hospital stays, along with a better rate of successful stoma reversal.
並列摘要
引言：複雜性穿孔結腸憩室炎是需要手術的腹部急症，其各種手術的死亡率與術後併發症比較仍有爭議。本篇目的在於分析本院接受Hartmann術式與初級吻合合併或不合併保護性腸道造廔患者之結果。方法：這項研究分析了26名患者，比較死亡率、術後併發症發生率、手術時間、住院時間、再手術率等差異。結果：三組之間的併發症發生率及死亡率無統計學上差異。Hartmann術式組別雖然其造口逆轉率較低，但手術時間最短。沒有保護性腸道造廔的初級吻合組別有較短的住院時間。結論：Hartmann術式對於急性複雜性穿孔結腸憩室炎的生命徵象不穩定患者很重要，但有無法逆轉造口風險。我們統計結果顯示，若在緊急手術期間穩定的患者，初級吻合（合併或不合併保護性腸道造廔）是一種替代選擇。