The Clinical Application Value Of Standardized Anal Expansion In The Prevention Of Anastomotic Stenosis After Anus-preserving Operation For Low Rectal Cancer

Objective:To compare and analyze the patient data and short-term clinical effect differences of patients with low rectal cancer anus preservation surgery+ preventive stoma with standardized anus enlargement and non-expansion,and to explore the difference in short-term clinical effect of low rectal cancer anus preservation surgery+preventive stoma after standardized expansion The clinical application value of the anus.Methods:Selected patients who underwent low rectal cancer anus preservation surgery+preventive ileostomy in the gastrointestinal surgery department of our hospital from January 2016 to June 2020.All operations were laparoscopic surgery and passed certain inclusion and exclusion criteria.A total of 90 patients who met the criteria were divided into 50 patients in the anus enlargement group and 40 patients in the control group according to whether the anastomosis was standardized after the operation.Patients in the anal expansion group regularly expand the anastomosis after the operation.Our method is to use an anal expansion rod to expand the anastomosis,and the patient can do it at home.After the operation and before discharge from the hospital,the patient and family members will be taught about the expansion of the anal rod expansion anastomosis,so that the patient and family members will be proficient in the expansion of the anastomosis method.Two weeks after the operation,the expansion rod will be used to expand the anastomosis.The front end of the expansion rod is thicker.Apply paraffin oil to the site to make the front end of the anal expansion rod at the anastomosis.The model of the expansion anal rod is No.6(diameter 6mm)-No.32(diameter 32mm).The initial anal expansion rod model should be slightly larger than the diameter of the anastomosis.Twice in the morning and evening,30min each time,the size of the anal rod can be increased by 2mm each week,until the diameter of the anastomotic stoma and the diameter of the intestine are the same or not much different,generally lasting 3-6 months or continuing to expand the anus to receding Preventive stoma.After the stoma is reintroduced,it is still necessary to continue to standardize the anus for 4-6 weeks to avoid anastomotic stenosis.Regular follow-up after operation,the follow-up time is from the postoperative period to the ileostomy return period The general data,perioperative data,pathological data,postoperative complications data,and anastomotic complications data of the two groups of patients were respectively counted.SPSS23.0 software was used for data calculation and analysis,the measurement data was subjected to t-test,and the count data was subjected to chi-square Test,P<0.05 is considered to be statistically different.Results:The general clinical data of the two groups of patients including age,gender,BMI,history of abdominal surgery,underlying diseases and ASA were not significantly different P>0.05.The perioperative data of the two groups of patients including operation time,blood loss,bowel function recovery time and postoperative hospital stay were not significant P>0.05.The pathological data of the two groups of patients included tumor size,the distance from the lower edge of the tumor to the anus,T stage and pathological stage were not significant P>0.05.The postoperative stoma complications of the two groups of patients included parastoma hernia,stoma prolapse,stoma collapse,stoma bleeding,stoma retraction,and periostoma dermatitis.P>0.05.Postoperative complications of the two groups of patients included anastomotic leakage,abdominal hemorrhage,lung infection,abdominal infection,and urinary retention.P>0.05,but the control group was found through digital examination,radiography and colonoscopy during the follow-up process.Anastomotic stenosis occurred in 8 of 40 patients,and anastomotic stenosis occurred in 2 of 50 patients in the dilatation group.Both stenosis occurred after the anal expansion stopped after the stoma was restored.P<0.05,there was a difference.Statistical significance.Conclusion:1.Standardized anus expansion can effectively reduce the possibility of anastomotic stenosis after low rectal cancer surgery+preventive stoma,reduce the severity of anastomotic stenosis,make the patient’s ileostomy as early as possible,and reduce the patient’s pain.2.Standardized anal expansion is a safe,practical and feasible effective measure to prevent anastomotic stenosis after ileostomy.3.It is still necessary to continue expanding the anus for 4-6 weeks after the stoma is reinstated to avoid recurrence of stricture.