目的 分析并总结Hartmann手术后造口回纳的方式及注意事项.方法 回顾性分析2005年2月至2016年2月行Hartmann术后造口回纳12例患者的临床资料.根据手术方式及直肠残端位置进行分组.结果 1例回肠与直肠残端固定后造口及3例直肠残端在初次手术时固定于左侧盆壁者手术均很顺利,手术时间85～120min,平均106min.而其余8例手术时间205～260min,平均237min,且术中损伤小肠3例,作肠切除2例,肠修补1例,损伤输尿管1例,修补后放J形管;术中输红细胞2例;作暂时性回肠造口3例.本组发生切口感染2例,术后肠瘘1例,经保守治疗治愈.结论 初次Hartmann手术时应考虑患者今后是否会作造口回纳手术,对年龄较轻,经济条件较好,对生活质量要求较高,良性病变或虽为恶性肿瘤但有可能根治的患者,术中应为回纳手术创造条件,将直肠残端拉直后固定在盆壁上,尽量避开输尿管与髂窝大血管,并在手术记录上详细描述,以供今后回纳手术医师参考.%Objective To analyze and summarize the way and precautions of anastamosis returning after Hartmann surgery.Methods A retrospective study was conducted on 12 cases of Hartmann postoperative ostomy in February 2005 to February 2016 in the First Hospital of Jiaxing City.Grouping was performed according to the surgical approach and the location of the rectum stump.Results 1 case of ileum and rectal stump fixed stoma and 3 cases of rectal stump in the initial operation was fixed in the left basin of the operation were very smooth, the operation time was 85-120min, with an average 106min.While the remaining 8 cases operation time 205-260min, average 237min, and intraoperative injury 3 cases of small intestine and intestinal resection for 2 cases, intestinal repair in 1 cases, 1 cases of ureteral injury and repair after J tube;intraoperative red blood cell transfusion in 2 cases;for temporary ileostomy in 3 cases.In this group, 2 cases of incision infection, postoperative intestinal fistula in 1 cases, cured by conservative treatment.Conclusion When the first time Hartmann surgery must to be think if patients in the future will be made for mouth stoma surgery, for the age is not good, better economic conditions, higher quality of life requirements, benign lesions or malignant tumors but may cure patients, intraoperative it is necessary to create the conditions for the future return surgery.The rectal stump straightened to the pelvic wall, try to avoid large blood vessels in the ureter and iliac fossa, and detailed description of the surgical records for future reference to the surgeon surgeon.
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