Application Of Laparoscopic-assisted Transanal Total Mesorectal Resection With Anus-preserving Radical Mastectomy In The Anus-preserving Treatment Of Low Rectal Cancer

Objective To investigate the application of laparoscopic-assisted total mesorectal resection and artificial anastomosis in the treatment of low rectal cancer.The operative time,the amount of blood loss,the number of lymph nodes removed,the distance between the distal margin and the lower margin of the tumor,the Wexner score of anal function at 3 and 6 months after surgery,the surgical effect,postoperative complications,the 1-year and 2-year survival rates and the recurrence rate of the tumor were analyzed.Methods Matching study,Department of Gastrointestinal Surgery,10th People’s Hospital Affiliated to Tongji University,from November 2018 to November 2020,laparoscopic-assisted total mesorectal resection with anal preserving radical resection--artificial anastomosis was performed according to surgical indications and willingness.Patients who met the standards of laparoscopic-assisted total mesorectal resection with anus-preserving radical resection--manual anastomosis and those who underwent laparoscopic Dixon--stapler anastomosis were selected for matching.Seventy-eight patients with low rectal cancer(rectal cancer 7 cm or less from the anal margin)were divided into control group(n=39,laparoscopic Dixon--stapling anastomosis)and experimental group(n=39,laparoscopic total mesorectal resection--anal preserving radical anastomosis)according to the surgical methods.The surgical effect of the two groups was observed.Compare two groups of indicators related to the operation(operation time,intraoperative blood loss,the number of lymph node removal,far cut edge distance from the edge of tumor),complications,anastomotic leakage,intestinal obstruction,anastomotic bleeding,anal pain,autonomous urination dysfunction,sexual function),anus function(Wexner score including living habits,defecation,then,exhaust,hard liner change in five aspects,The score was 0-4,with a total score of 0-20,0 being normal anal function.1-10 is good function;11-19 points for poor function;20 was total incontinence),1 year and 2 year survival after surgery,and tumor recurrence rate.Results Comparison of surgery related indexes between the two groups:The intraoperative blood loss of the experimental group was(73.30±8.37)ml compare with that of the control group(82.65±9.20)ml,P=0.000<0.05.The experimental group had a significant advantage.The distance between the distal edge and the lower edge of the tumor was(1.80±0.68)cm in the experimental group and(3.10±0.52)cm in the control group.P=0.000<0.05,the normal rectal tissue resection was less in the experimental group.n of normal rectal tissue.Comparison of clinical surgical efficacy between the two groups:The chi-square value of the two groups was 6.788,P=0.034<0.05,the difference was statistically significant.The results indicated that the therapeutic effect of experimental group was significantly higher than that of control group.Anal function after operation in the two groups:Wexner scores were compared between the experimental group and the control group at 3 months and 6 months after operation respectively,P=0.543>0.05,the difference was not statistically significant.Wexner scores at 3 and 6 months after surgery were compared between groups,P=0.034<0.05,P=0.026<0.05,the scores of the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05).Comparison of postoperative complications between the two groups:the incidence of postoperative complications such as anastomotic leakage,anastomotic bleeding,intestinal obstruction,anal pain,dysuria and sexual dysfunction in the experimental group was compared with observation,χ2 test was used for comparison between the groups,P=0.097>0.05,the difference was not statistically significant.There was no significant difference in 1 year and 2 year survival rate and tumor recurrence rate between the two groups.Conclusion 1.Laparoscopic assisted transanal total mesorectal excision with anus preserving radical resection and artificial anastomosis is used to treat low rectal cancer,which can maximize the preservation of healthy bowel in the lower rectum and achieve good control effect.2.The amount of bleeding was significantly less.3.The clinical effect after operation is exact effect is exact,which is worthy of clinical promotion.