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Primary colon resection or hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

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World Journal of Gastrointestinal surgery 2013年第1期5卷 1-4页

作者： Reinhart T Grundmann Formerly Kreiskliniken Alt tting D-84489 BurghausenGermany

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel *** resection and anastomosis offers the advantages of a definite procedure without need for further *** main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency *** resection with end colostomy(hartmann's procedure) is considered the safer *** et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(sEMs) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel *** authors concluded that the technical and clinical success rates for stenting were lower than *** was associated with a high incidence of clinical and silent *** instead of loop colostomy can be recommended only if the appropriate expertise is available in the *** goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency *** now,this was not demonstrated in a prospective randomized trial.

关键词： Left-sided large bowel obstruction hartmann’s procedure Primary anastomosis Bowel stent Emergency treatment

hartmann's术后直肠袋随访所见(英)

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国际外科学杂志 1990年第3期 186-186页

作者：赵宏邢春根

hartmann手术通常适应于直肠肿瘤、憩室炎、炎性肠病及创伤,其优点是操作容易,并发症少.文献多数主张行二期手术以恢复肠道延续性,少数病人于首次术后已经康复而勿需二期手术.但残留在患者体内的直肠袋年久后可发生癌肿、息肉及炎症.本... 详细信息

hartmann手术通常适应于直肠肿瘤、憩室炎、炎性肠病及创伤,其优点是操作容易,并发症少.文献多数主张行二期手术以恢复肠道延续性,少数病人于首次术后已经康复而勿需二期手术.但残留在患者体内的直肠袋年久后可发生癌肿、息肉及炎症.本文用纤维结肠镜对45例hartmann’s术后患者进行了随访,现报道如下:病人和方法:作者对1969～1988年间行hartmann手术同时符合下列标准的45例患者进行了病史复习和术后随访.选择病人的标准是:(1)术后超过1年者;(2)术后已完全恢复者;(3)切缘应距肿块至少3cm,肿瘤和息肉应完全切除;有淋巴结、肝转移时,术后生存1年以上者;(4)不准备行任何其他

关键词：直肠患者大肠 hartmann’s 炎性肠病憩室炎二期手术直肠炎直肠疾病无症状

Plasma-Lyte 148: A clinical review

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World Journal of Critical Care Medicine 2016年第4期5卷 235-250页

作者： Laurence Weinberg Neil Collins Kiara Van Mourik Chong Tan Rinaldo Bellomo Department of surgery Perioperative Pain Medicine Unit University of Melbourne Depart-ment of Anesthesia Austin Hospital Department of Anesthesia Joondalup Health Campus Department of Intensive Care Austin Hospital

AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative *** We performed an electronic literature search from Medline and Pub Med(via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate". All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. REsULTs We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and *** Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of PlasmaLyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.

关键词： surgery Anesthesia Fluid therapy Crystalloids saline Plasma-Lyte hartmann’s Ringers Acetate Gluconate Lactate

比较在之间开并且为憩室炎的 hartmanns 过程的 laparoscopic 颠倒

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World Journal of Gastrointestinal surgery 2013年第8期5卷 245-251页

作者： Nicola de’Angelis Francesco Brunetti Riccardo Memeo Jose Batista da Costa Anne sophie schneck Maria Clotilde Carra Daniel Azoulay Digestive and Transplant Liver surgery Unit Henri-Mondor HospitalUniversité Paris Est Department of Dentistry Rothschild Hospital

AIM: To compare the open and laparoscopic hartmann’s reversal in patients first treated for complicated ***: Forty-six consecutive patients with diverticular disease were included in this retrospective,singlecenter study of a prospectively maintained colorectal surgery *** patients underwent conventional hartmann’s procedures for acute complicated *** indications for hartmann’s procedures were *** underwent open(OHR) or laparoscopic hartmann’s reversal(LHR) between 2000 and 2010,and received the same pre-and post-operative protocols of *** variables,length of stay,short-(at 1 mo) and long-term(at 1 and 3 years) postoperative complications,and surgery-related costs were compared between ***: The OHR group consisted of 18 patients(13 males,mean age ± sD,61.4 ± 12.8 years),and the LHR group comprised 28 patients(16 males,mean age 54.9 ± 14.4 years).The mean operative time and the estimated blood loss were higher in the OHR group(235.8 ± 43.6 min vs 171.1 ± 27.4 min;and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively,P = 0.001).Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group,and 3 ± 1.3 d in the LHR group(P = 0.01).The length of hospital stay was significantly longer in the OHR group(11.2 ± 5.3 d vs 6.7 ± 1.9 d,P s 33.3% in the OHR(6 wound infections) and 3.6% in the LHR group(1 hemorrhage)(P = 0.004).At 12 mo,the complication rate remained significantly higher in the OHR group(27.8% vs 10.7%,P = 0.03).The anastomotic leak and mortality rates were *** 3 years,no patient required re-intervention for surgical *** OHR procedure had significantly higher costs(+56%) compared to the LHR procedure,when combining the surgery-related costs and the length of hospital ***: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays,complication rates,and costs compared to OH

关键词： hartmann’s procedure hartmann’s reversal Diverticular disease Laparoscopy Healthcarerelated costs Colorectal surgery