| Background and ObjectiveRectal cancer(RC)is a malignant carcinoma from the junction of the sigmoid rectum to the dentate line.Rectal cancer is one of the most common malignant tumors in the world,with the change of diet structure,the morbidity of rectal cancer is increasing year by year,which is now situated in third.There are about 2 million new cases of colorectal cancer patients worldwide every year,of which 600 thousand patients died of colorectal cancer.The distribution of rectal cancer has significant geographical differences in the world,the morbidity rate of the overall trend in developed areas is higher than that in underdeveloped areas,and the incidence of high-risk area is 10 times than that in the low incidence area.Australia,New Zealand,Europe and North America have the highest morbidity of rectal carcinoma,while the morbidity of rectal carcinoma is the lowest in Middle-west Africa and Middle-south Asia.However the proportion of the incidence of rectal carcinoma and the number of deaths in China is still high in Asia and even around the world.In our country,the incidence rate of rectal cancer is increasing year by year with the annual growth rate of 4.2%,at present,which is situated in third in all malignant carcinomas,and the mortality rate is in the fifth place.Rectal cancer is more likely to cause intestinal stenosis and obstruction due to the growth of the infiltration of the ulcer.Traditionally,when treating rectal cancer with intestinal obstruction,these patients should undergo transverse colostomy in the proximal of the obstruction in the first,after being fully improved bowel preparation,then finish two stage of radical resection surgery.With the change of the concept of treatment,improvement and development of intestinal tract anastomat,and the use of antibiotics,many scholars conduct various attempts,the therapy of rectal cancer with intestinal obstruction could be feasible to radical resection and primary anastomosis,namely one stage Dixon radical resection,if preoperative without intestinal preparation and much feces in it,it also could be anastomosis after intraoperative colonic lavage.One stage Dixon radical resection after intraoperative colonic irrigation and selective Dixon radical resection operation after placement of metal stents are the two most common surgical methods for rectal cancer with intestinal obstruction.To observe the treatment effects and prognosis of two surgical methods for the treatment of rectal cancer with obstruction patients,from January 2010 to September 2016,there are 118 cases of rectal cancer with obstruction patients in the Department of general surgery of the Second Affiliated Hospital of Zhengzhou University and Henan Cancer Hospital,who were treated with one stage Dixon radical resection after intraoperative colonic irrigation or selective Dixon radical resection operation after placement of metal stents.In order to provide a reasonable basis for the clinical treatment of rectal cancer complicated with intestinal obstruction,we compared the operation time,intraoperative bleeding loss,postoperative length of stay,postoperative exhaust time for the first time,the short-term complication rate,change of serum albumin levels during perioperative period and CEA levels change before and after surgery of the two kinds of operation.MethodsThis research takes the patients who underwent One stage Dixon radical resection operation of rectal cancer with obstruction,from January 2010 to September 2016,in the department of General Surgery of the Second Affiliated Hospital of Zhengzhou University and Henan Cancer Hospital as the research subject.According to the different operation methods,we divided them into two groups,one is the observation group(one stage Dixon radical resection after intraoperative colonic irrigation)(n = 62)and the other is the control group(selective one stage Dixon radical resection operation after placement of metal stents)(n=56).Then,we collected all the patients’ basic information,operation information,and then th gender,pathological classification,pathology of two groups of patients were analyzed by χ2 test,which were no statistically significant difference,and had comparability.Results1.The average operation time of the observation group was longer than that of the control group,the average amount of bleeding was more than that of the control group,the difference between the 2 groups was statistically significant(P<0.05).2.The average postoperative exhaust time of the observation group was earlier than that of the control group,the average hospitalization time was longer than that of the control group,but the difference was not statistically significant(P>0.05).3.There was no significant difference in the incidence of early complications(anastomotic leakage,wound infection,intestinal obstruction)between the 2 groups(P>0.05).4.Comparison of serum albumin levels during perioperative period,which was no significant difference in 2 groups(P>0.05).5.The CEA level between preoperative and postoperative had changed in 2 groups,of which that preoperative CEA levels were increased in varying degrees,and the difference was not statistically significant(P>0.05).The postoperative CEA level in 2 groups decreased significantly.The CEA difference between preoperation and postoperation for 3 months in 2 groups,which was statistically significant(P<0.05).The difference between the 2 groups by statistical analysis,which was not statistically significant(P>0.05).6.The recurrence rate of the observation group was higher than that of the control group,but there was no significant difference between the 2 groups(P>0.05).Conclusion1.Compared One stage Dixon radical resection after intraoperative colonic irrigation with selective Dixon radical resection operation after placement of metal stents,which could be considered that the operation in the observation group was more complicated than that of the control group,however,the incidence of early postoperative complications and the risk of long-term recurrence and metastasis did not increase in the observation group.2.It was suggested that compared with selective surgery,one stage Dixon radical resection after intraoperation colonic irrigation could also improve the nutritional status of the patients,and could quickly solve the symptoms of intestinal obstruction,even avoid survival with cancer.3.Under the premise of strictly mastering of the surgical indications and full intraoperative colonic irrigation,standardize the operative procedures,strengthening postoperative management,rectal cancer with obstruction underwent a single-stage Dixon radical operation is safe and feasible. |
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