| Objective To explore the feasibility and safety of extraperitoneal stoma combined with pelvic floor peritoneal closure in laparoscopic abdominoperineal resection((laparoscopic abdominoperineal resection,LAPR).Compared with intraperitoneal sigmoidostomy and non-closure of pelvic floor peritoneum,the clinical effects of the two surgical methods were compared,and the advantages of extraperitoneal colostomy combined with pelvic floor peritoneal closure were evaluated.The purpose of this study is to provide a theoretical basis for the application of extraperitoneal stoma combined with pelvic floor peritoneal closure in LAPR.Methods The clinical and data of patients with low rectal cancer who underwent laparoscopic abdominal perineal resection in our hospital from March 2014 to January 2019 were analyzed retrospectively.The screening was carried out according to the strict inclusion and exclusion criteria established in this study.103 patients were selected into this study,and their detailed data extraction and follow-up were carried out.Because the patients did not cooperate with the follow-up and 5 cases lost follow-up due to the cause of death,98 cases were included in this study.According to the way of colostomy and the treatment of pelvic floor peritoneum,the patients were divided into two groups: control group(n =53)and extraperitoneal stoma combined with pelvic floor peritoneum closure group(n=45).A total of 45 cases were divided into two groups: the control group(n=53)and the extraperitoneal stoma combined with pelvic floor peritoneum closure group(n=45).The general data,clinical data,operation-related conditions,postoperative complications and postoperative defecation function of the two groups were recorded.The colostomy function evaluation scale was used to evaluate the defecation function of stoma after operation.Results(1)Comparison of general data: there was no significant difference in the baseline information between the two groups and was comparable.(2)Operation and postoperative recovery: the patients in both groups completed the operation successfully and there was no conversion to laparotomy.The total operation time of the study group and the control group was(157.7±36.3)min and(161.2±33.1)min,respectively.The intraoperative bleeding volume was(68.9±52.7)ml and(72.8 ±48.3)ml,respectively.The first exhaust time after colostomy was(2.1 ± 0.9)days and(2.6 ± 1.3)days,respectively,(P > 0.05).However,the postoperative hospital stay in the study group and the control group was(9.2±1.9)days and(10.4±2.3)days respectively,(P<0.05).The time for LAPR to close the pelvic floor peritoneum was(13.2 ± 1.4)min.(3)Postoperative complications: The difference in the incidence of total stoma-related complications between the two groups was statistically significant(37.8% vs 73.6%),with the incidence of parastomal hernia at 4.4%(2/45)and 18.9%(10/53),stoma prolapse at 0%(0/45)and 13.2%(7/53),and stoma oedema at 24.4%(11/45)and9.4%(5/53),(P<0.05).The incidence of intra-abdominal hernia was 2.2%(1/45)and13.2%(7/53),stoma stricture was 4.4%(2/45)and 7.5%(4/53),stoma retraction was0%(0/45)and 5.7%(3/53),and stoma necrosis was 2.2%(1/45)and 5.3%(3/53)in the two groups,respectively.Perineal-related complications: the incidence of perineal incision infection was 4.4%(2/45)and 17.0%(9/53),the incidence of perineal incision dehiscence was 2.2%(1/45)and 15.1%(8/53),the incidence of perineal hernia was 0%(0/45)and 13.2%(7/53),the incidence of adhesive bowel obstruction was 0%(0/45)and 15.1%(8/53),and pelvic floor peritoneal hernia incidence of 2.2%(1/45)and17.0%(9/53),respectively,(P<0.05).(4)The stoma function: defecation stimulation,defecation stimulation time,24-hour defecation frequency,defecation control ability and defecation regularity in the study group were better than those in the control group,(P < 0.05).In time of the duration of defecation and the shape of defecation between the two groups,(P > 0.05).Conclusion(1)Extranaperitoneal colostomy combined with pelvic floor peritoneal closure has a certain degree of safety and effectiveness in laparoscopic combined abdominal and perineal resection.(2)Extraperitoneal colostomy combined with pelvic floor peritoneal closure can reduce the incidence of stoma related complications,especially parastomal hernia and stoma prolapse,and reduce the risk of perineal related complications.(3)Extraperitoneal colostomy combined with pelvic floor peritoneal closure can shorten postoperative hospital stay,and improve postoperative stomal defecation function,especially the ability of defecation stimulation and defecation control,and improve postoperative quality of life. |
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