哈特曼逆转:一个具有挑战性的手术的争议。

IF 1.3 Q3 SURGERY
Minimally Invasive Surgery Pub Date : 2022-11-09 eCollection Date: 2022-01-01 DOI:10.1155/2022/7578923
Claudia Reali, Kalle Landerholm, Bruce George, Oliver Jones
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引用次数: 0

摘要

目的:Hartmann逆行术是一种复杂的手术,发病率高。微创手术已被用于减少手术对脆弱患者的影响。这个比较研究的目的是看看哈特曼的逆转程序与不同的方法的结果。方法:回顾性收集所有行Hartmann逆转的患者124例。开腹手术64例(50.4%),常规腹腔镜入路6例(5%),单切口腹腔镜手术34例(28.1%),需另外加套管针20例(16.5%)。结果:SILS手术时间略长于开放手术(175 min vs 150 min),术后并发症和再手术发生率相同(p = 0.83和p = 0.42),但住院时间较短(5天p = 0.007)。年龄(p = 0.03)、手术时间长(p = 0.01)、ASA评分(p = 0.05)是影响术后发病率的独立因素。粘连程度越高,手术时间越长(p = 0.001),转归风险越高(p < 0.001),直肠残端越短,保护性回袢造口风险越高(p = 0.008)。2-3级粘连患者住院时间较长(p = 0.05)。结论:与开放性病例相比,微创手术的住院时间更短,并且没有显示出任何发病率的增加。年龄、较长的手术时间和ASA评分增加了术后并发症的发生风险。此外,直肠残端较短的患者有较高的机会进行功能障碍的回肠造口术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Hartmann's Reversal: Controversies of a Challenging Operation.

Hartmann's Reversal: Controversies of a Challenging Operation.

Purpose: Hartmann's reversal is a complex operation with a high morbidity rate. Minimally invasive surgery has been used to reduce the impact of surgery on fragile patients. The aim of this comparative study is to look at the results of Hartmann's reversal procedures with different approaches.

Methods: All the patients who underwent Hartmann's reversal were collected retrospectively (124 cases). Sixty-four patients (50.4%) had an open operation, 6 cases (5%) were treated with a conventional laparoscopic approach, 34 patients (28.1%) underwent single incision laparoscopic surgery (SILS), and 20 (16.5%) required other additional trocars.

Results: SILS operations were slightly longer than the open procedures (175 min vs 150 min), with the same rate of postoperative complications and reoperations (p = 0.83 and p = 0.42), but with a shorter hospital stay (5 days p = 0.007). Age (p = 0.03), long operative time (p = 0.01), and ASA score (p = 0.05) were identified as independent factors affecting postoperative morbidity. The grade of adhesions caused a longer operative time (p = 0.001) and a higher risk of conversion (p < 0.001), and short rectal stump increased the risk of protective loop ileostomy (p = 0.008). Patients with grade 2-3 of adhesions had a longer length of stay (p = 0.05).

Conclusions: Minimally invasive procedures had a shorter hospital stay and did not show any increase in morbidity rate when compared with open cases. Age, longer operative time, and ASA score increased the risk of postoperative complications. Furthermore, patients with a short rectal stump had a higher chance of having a defunctioning ileostomy.

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来源期刊
CiteScore
3.00
自引率
0.00%
发文量
8
审稿时长
16 weeks
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