| Objective: The rate of post-surgery anal preservation in patients with middle or low rectal cancer surgery has increasingly been promoted and improved,however most patients complain about abnormal postoperative anal function.This study aimed to(1)evaluate the changes of the patient’s QOL and the relationship between QOL scores and defecation symptoms at various stages in the anal preservation surgery of patients with middle or low rectal cancer by using SF-36 questionnaire surveys,(2)objectively and subjectively evaluate the influence of preventive ileostomy combined with a succus entericus reinfusion for anorectal functions after anal preservation surgery in patients with middle or low rectal cancer by anorectal manometry combined with the Wexner Score,and(3)compared the influence of laparoscope-guided surgeries and laparotomy on postoperative anorectal functions and defecation symptoms after anal preservation surgery in patients with middle or low rectal cancer.Methods: The clinical data and corresponding investigation results of patients with middle or low rectal cancer who had received anal preservation surgery in the Department of General Surgery in Huangdao Hospital of the Affiliated Hospital of Qingdao University from January 2015 to June 2016 were retrospectively investigated and analyzed.SF-36 QOL questionnaires and defecation symptoms were investigated after postoperative periods at 1,3,and 6 months after surgery in patients either with preventive ileostomy or sigmoidostomy,as well as the correlation between QOL scores and defecation symptoms were analyzed.The changes of postoperative anorectal functions were evaluated by anorectal manometry,combined with Wexner Score,in patients without preventive ileostomy,with preventive ileostomy,and with preventive ileostomy combined with succus entericus reinfusion in order to analyze the relationship between anorectal manometry results and the Wexner Score.The influence of a laparoscopeguided surgery and laparotomy on postoperative anorectal functions and defecation symptoms after anal preservation surgery in patients with middle or low rectal cancer was compared.Results: A total of 56 patients with middle or low rectal cancer who received anal preservation surgery were enrolled,among whom 27 were without preventive ileostomy (no-preventive ileostomy group)and 29 had completed a preventive ileostomy(preventive ileostomy group.).The results of the postoperative SF-36 QOL questionnaires showed that the scores of 8 functioning scales and 2 comprehensive scales had gradually increased over time within two groups.It indicated that the patients’ postoperative QOL continuously improved.There were insignificant differences in the 2 comprehensive scales 1,month after postoperative analysis between the two groups,however,nopreventive ileostomy group was higher than a preventive ileostomy group in the social function score(57.67±16.32 vs 42.43±10.76,P<0.05).The preventive ileostomy group was markedly better than the non-preventive ileostomy group in the body health score 3 months post-surgery(39.2±15.76 vs 25.87±14.31,P<0.05),however there were also insignificant differences in the mental health score.Furthermore,the preventive ileostomy group was also higher than the non-preventive ileostomy group in patients’ vitality(56.71±20.24 vs 44.32±12.9,P<0.05).There was no significant difference between the two groups in the 2 comprehensive scales 6 months after operation;however,the preventive ileostomy group was higher than the non-preventive ileostomy group in the results of the social function score(78.28±19.75 vs 66.17±20.31,P<0.05).Patients’ postoperative body health score and mental health score were negatively associated with the defecation frequency and encopresis score respectively(r=-0.451,P=0.024,r=-0.553,P=0.012).27 cases of low rectal cancer patients with anal preservation and 26 cases with permanent sigmoid colostomy were analyzed.The mental health score of anal preservation group was higher than that of sigmoidostomy group in 1 month after the operation(31.76±14.85 vs 19.14±7.64,P<0.05).3 months after the operation the quality of life of patients in 8 sub scales showed no significant differences.The mental health score of anal preservation group was better than sigmoidostomy group(41.21±12.38 vs 28.53±11.92,P<0.05),however the body health score of the sigmoidostomy group was better than the anal preservation group(41.83±16.76 vs 25.87±14.31,P<0.05).There was no significant difference between the two groups of QOL in 6 months after the operation Another 17 patients with middle or low rectal cancer who had received anal preservation surgery with preventive ileostomy + succus entericus reinfusion(preventive ileostomy + succus entericus reinfusion group)had been enrolled.The anorectal manometry results showed the anal canal rest pressure in the anorectal functions,the maximum rectal tolerance volume,and the rectal compliance had increased over time,however there were no significant differences in the postoperative maximum squeeze pressure and anorectal inhibition reflex.The non-preventive ileostomy group results were markedly better than the preventive ileostomy group(117.7±38.1ml vs 70.1±27.3ml,P=0.039,5.2±1.5 vs 1.8±0.9,P=0.026)and preventive ileostomy+succusentericus reinfusion group(117.7±38.1ml vs 90.2±32.3ml,P=0.037,5.2±1.5 vs 3.0±1.3,P=0.027)regarding the maximum rectal tolerance volume and rectal compliance 1 month post-surgery.The non-preventive ileostomy group and preventive ileostomy + succusentericus reinfusion group were significantly better than the preventive ileostomy groupregarding the maximum rectal tolerance volume and rectal compliance(120.5±33.9ml vs 84.1±24.6ml,P=0.029,6.9±2.8 vs 4.2±1.8,P=0.011)while the non-preventive ileostomy group were noticeably better received than the preventive ileostomy group and preventive ileostomy + succusentericus reinfusion group regarding the anal canal rest pressure 3 months after surgery(59.2±17.1mm Hg vs 37.8±15.7mm Hg,P=0.026,59.2±17.1mm Hg vs 38.2±20.7mm Hg,P=0.029).There was no significant difference found among the 3 groups regarding anorectal functions 6 months after surgery.The Wexner Score displayed a gradual decrease within 6 months of postoperative treatment in patients with middle or low rectal cancer and the score was in negative association with the anal canal rest pressure,the maximum rectal tolerance volume,and rectal compliance(r=-0.487,P=0.018,r=-0.522,P=0.012,r=-0.469,P=0.022).A total of 21 patients(laparoscopy group)with a middle or low rectal cancer diagnosis who had received laparoscope-guided surgery,as well as another 18(laparotomy group)who had received laparotomy were enrolled in this study.The Laparoscopy group had excellent advantages regarding intra-operative hemorrhagic volumes,postoperative evacuation times,and postoperative hospital stays than the laparotomy group(130.5±40.3min vs 90.8±35.2min,P<0.05,70.1±21.8ml vs 120.5±33.2ml,P<0.05,2.6±1.1d vs 4.2±1.4d,P<0.05,1 case vs 4 cases,P<0.05).The laparoscopy group had a longer surgical duration and was higher in anal canal rest pressure(54.1±13.2mm Hg vs 42.3±11.7mm Hg,P<0.05)1 month after surgery than the laparotomy group.Meanwhile,the differences in other anorectal manometry results and defecation symptoms 1,3,and 6 months after surgery were statistically insignificant between the two groups.Conclusion: The postoperative QOL and anal function indexes had gradually improved in patients with middle or low rectal cancer who had received anal preservation surgery.An increased defecation frequency and encopresis are two important factors that influence the patients’ postoperative QOL.Succus entericus reinfusion has had a positive effect in improving the anorectal function recovery in patients with preventive ileostomy.The recovery of maximum tolerance volume,rectal compliance and anal resting pressure benefited the anorectal function and defecation symptoms.In addition,the laparoscopyguided surgery had a positive effect on the postoperative early recovery of the patients’ anal rest pressure,however there was no significant difference between the laparoscopyguided surgery and laparotomy in the patients’ postoperative defecation symptoms.The laparoscopy-guided surgery had an advantage of enhanced recovery after surgery compared with the laparotomy. |
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