The Application Of Defunctioning Stoma In Laparoscopic Sphincter-preserving Surgery For Low Rectal Cancer

ObjectiveBy comparing the short-term clinical efficacy of preventive terminal ileostomy group,preventive transverse colostomy group and non-stoma group in laparoscopic anus preservation surgery for low rectal cancer,to discuss the safety,feasibility and clinical value of defunctioning stoma.The clinical data of the two stoma closure groups were collected to further compare the advantages and disadvantages between them,so as to provide reference value for clinical selection.MethodFrom January 2013 to July 2018,a total of 156 patients undergoing the laparoscopic anus preservation surgery for low rectal cancer at our hospital are collected with the clinical data for retrospective study.According to the methods of stomy,the patients are divided into three groups: the preventive terminal ileostomy group with 58 cases(group A),preventive transverse colostomy group with 43 cases(group B)and non-stoma group with 55 cases(group C).This study presents the differences in clinical efficacy of defunctioning stoma group and non-stoma group,preventive terminal ileostomy group and transverse colostomy group by comparing the differences in the duration of hospital stay,hospitalization cost,duration of operation,intraoperative blood loss,postoperative recovery,postoperative index of nutrition,inflammatory and immune,postoperative electrolyte status and complications among these three groups.In addition,the clinical data of the two stoma reversal groups are collected,including the reversal rate,reversal time,length and cost of hospitalization,duration of operation,intraoperative blood loss,postoperative recovery,stoma-related and other postoperative complications,to further compare the advantages and disadvantages of the two stomy methods.Results1.There are no significant differences among three groups in terms of gender,age,BMI,tumor TNM stage,tumor size,pathological type,number of lymph node dissection,distance between tumor and anal margin and other general data(P>0.05).In terms of the duration of hospital stay and operation,the postoperative time of getting out of bed,time of stoma/anal exhaust,time of fluid intake,there are statistically significant differences between the defunctioning stoma groups and non-stoma group(P<0.05).But there are no significant differences in the hospitalization cost,postoperative time of infusion and time of removal of pelvic drainage tube between them(P>0.05).With regard to the index of nutritions(serum albumin and total protein),there are no significant differences in the pre-operation and the 1st day after operation between the defunctioning stoma groups and non-stoma group(P>0.05).However,on the 7th day after operation,there is a significant difference in the index of serum albumin between them(P<0.05).As for the indexes of inflammatory,immune and postoperative electrolyte status,there are no significant differences in the pre-operation,the 1st day and the 7st day after operation among the three groups.With respect to the incidence of postoperative complications,there are significant differences in the incidence of anastomotic leakage and the total complications among the three groups(P<0.05).2.A total of 50 patients in the ileostomy group accepte stoma reversal,with the reversal rate of 86%,and 36 patients of the transverse colostomy group accepte stoma reversal,with the reversal rate of 83.7%.The differences of preoperative electrolyte,intraoperative blood loss,postoperative intestinal function recovery,and hospitalization cost in the two groups have no statistical significance(P>0.05).In the aspects of duration of surgery and hospitalization,the incidence of stoma-related dermatitis and the infection/liquefaction of surgical incision between the tow groups all have statistical significant differences(P<0.05).Conclusion1.The defunctioning stoma include the preventive terminal ileostomy and the transverse colostomy can reduce the incidence rate of anastomotic leakage and the clinical symptoms of leakage after laparoscopic operation for low rectal cancer with anal preservation,which can promote the postoperative rehabilitation and reduce postoperative complications and hospital stay.They have a protective effect for the patients and make them eat early.2.There is no significant difference between preventive terminal ileostomy group and the transverse colostomy group in laparoscopic sphincter-preserving surgery for low rectal cancer.But the duration of hospital stay and operation in the ileostomy reversal group was shorter than that in the transverse colostomy reversal group.Therefore,ileostomy is preferred without consideration of peristomy coprodermatitis.