Clinical Study On Reducing Anastomotic Leakage In Patients With High Risk Low Rectal Cancer By Intraoperative Protective Ostomy

Objectives:The main purpose of this study is to establish a scoring system for high-risk factors of anastomotic leakage in low rectal cancer,to screen out high-risk patients with anastomotic leakage,and to explore the protective effect of preventive ileostomy on postoperative anastomotic leakage in high-risk low rectal cancer patientsMethods:The clinical data of 231 patients who underwent Laparoscopic radical resection of low rectal cancer(preservable anus operation)from January 2014 to July 2019 in Yan an Hospital Of KunMin City were retrospectively analyzed and a database was established.In view of the possible factors related to anastomotic leakage,SPSS 17.0 software was used on 165 patients who Patients without protective ileostomy to carry out univariate analysis and multifactorial logistics analysis to screen the relationship between risk factors and anastomotic leakage,Assignment of risk factors.Then through statistical analysis,whether there is significant difference in the incidence of anastomotic leakage between patients with protective stoma and patients without protective stoma under high risk and low risk.Results:1.The incidence of anastomotic leakage for low rectal cancer was 8.5%(14/165).The incidence of anastomotic leakage in the protective stoma group was 4.55%(3/66)2.Through univariate analysis and multifactorial logistics analysis and screening of risk factors results:Gender,Age≥60,Smoking,diabetes and serum albumin are independent risk factors for anastomotic leakage.3.0-3 points for low-risk group and 4-6 points for high-risk group.The comparison of anastomotic leakage incidence between high-risk group and low-risk group has statistical significance(X2=11.292,P=0.001).4.There were 139 low-risk patients in 231 patients,including 26 patients in the stoma group,and the incidence of anastomotic leakage was 3.85%(1/26).There were 113 cases in non-stoma group,and the incidence of anastomotic leakage was 3.53%(4/113);Statistical analysis of the difference in anastomotic leakage incidence between the two groups(X2=0.006,P=0.940)showed no statistical significance.5.There were 92 high-risk patients in 231 patients,including 40 patients in stoma group,and the incidence rate of anastomotic leakage was 5%(2/40).There were 52 cases in non-stoma group,and the incidence of anastomotic leakage was 19.23%(10/52).Statistical analysis of the difference in anastomotic leakage incidence between the two groups(X2=4.037,P=0.045)has statistical significance.Conclusions:1.Serum albumin,Diabetes,Smoking,Male and Age≥60 are relatively independent risk factors for postoperative anastomotic leakage in low rectal cancer.2.In this scoring system,the incidence of anastomotic leakage is high in patients with low rectal cancer who score≥4 points and protective stoma can reduce the incidence of anastomotic leakage in low rectal cancer patients with high risk.