| Objective:At present,the industry’s controversy about the implementation of preventive stoma for patients with low and middle rectal cancer is mainly focused on its protective effect on anastomotic leakage,and there are relatively few discussions on its impact on patients’ related functions after surgery.This study explored the effects of preventive ileostomy on the anal function,urination function,sexual function,psychological status and quality of life in patients with anal-preserving laparoscopic middle and low rectal cancer after surgery,in order to broaden the prevention of middle and low rectal cancer The understanding of the value of sexual stoma provides a new reference for clinicians to choose a stoma.Methods:1.A retrospective case-control study was used to collect the clinical data of middle and low rectal cancer patients who underwent laparoscopic low rectal resection between September 2018 and September 2020 in our hospital.Criteria and exclusion criteria were screened,and patients were divided into preventive terminal ileostomy group and non-stoma group according to the presence or absence of preventive terminal ileostomy.Patients with a preventive stoma underwent a small intestinal stoma about 3 months after the radical operation.2.The Wexner fecal incontinence score scale was used to perform anal function follow-up scores in the stoma group and the non-stoma group at 1st,3rd,and 6th after anterior resection after transanal defecation;International Prostate Symptom Score Table(I,PSS),International Erectile Function Index Questionnaire(IIEF-5),Generalized Anxiety Disorder Scale(GAD-7),Health Questionnaire Depression Scale(PHQ-9),European Cancer Research and Treatment Organization Core Quality of Life Scale(EORTC QLQ-C30)was used to perform the urinary function,sexual function,psychological anxiety and depression status,and quality of life of the two groups of patients were scored at 1st,3rd,and 6th after anterior resection.Use SPSS 19.0 statistical software to perform statistical analysis on the clinical baseline data of the two groups of patients and the follow-up scoring data of each scale.The independent sample t test is used for the comparison of the measurement data conforming to the normal distribution,and the χ2 or Fisher test is used for the count data.Exact inspection.P<0.05 considered the difference to be statistically significant.Results:1.A total of 62 patients with anus-preserving middle and low rectal cancer were enrolled.There were 25 patients in the stoma group and 37 patients in the unstoma group.There was no statistical difference between the two groups in clinical baseline data such as gender,age,distance from the lower edge of the tumor to the anus,clinicopathological staging,length of operation,intraoperative blood loss and number of lymph node dissections(P>0.05).Anastomotic leakage occurred in one case(4%)in the stoma group.In the unstoma group,one case(2.7%)had incision infection and two cases(5.4%)had anastomotic leakage.The complications of the above enrolled cases were cured by conservative treatment.In the stoma group,1 case(4%)of stoma mucosal separation and 1 case(4%)of fecal watery dermatitis occurred during the stoma period,and they were successfully cured by symptomatic treatment and stoma care.2.The Wexner fecal incontinence score of the patients in the stoma group and the unstoma group after defecation through the anus was(3.4±4.1 vs 5.5±3.4,P<0.05)at 1 st and(1.9 ±3.3 vs 3.7 ± 3.3,P<0.05)at 3rd,(1.4 ± 2.7 vs 2.9 ± 3.0,P<0.05)at 6th.After defecation through the anus,both groups of patients had increased defecation frequency and poor bowel control to varying degrees,but with the passage of time,the defecation situation improved,and the stoma group showed better defecation control ability after defecation through the anus.Good,the difference between each follow-up time point is statistically significant(P<0.05).3.The International Prostate Symptom(IPSS)score of male patients in the stoma group and the unstoma group was(7.8 ± 2.2 vs 8.4 ± 2.5,P>0.05)at 1st after surgery,and(5.3 ±1.1 vs 5.4 ± 1.4,P>0.05)at 3rd,(3.1 ± 0.9 vs 2.7 ± 0.9,P>0.05)at 6th;the International Index of Erectile Function(IIEF-5)score was(10.9±1.7 vs 10.0 ±1.5,P>0.05)at 1st after surgery,(16.4 ± 1.8 vs 16.0±1.1,P>0.05)at 3rd,and(19.9 ± 1.3 vs 19.5 ± 0.8,P>0.05)at 6th.The urinary function and erectile function scores of the two groups of male patients after radical surgery were compared at each follow-up time point,and the difference was not statistically significant(P>0.05).4.The Generalized Anxiety Disorder Scale(GAD-7)score of patients in the stoma group and the unstoma group was(5.9 ± 1.4 vs 4.6 ± 1.2,P>0.05)at 1 st after surgery,and(4.9±1.0 v3 3.3± 1.0,P>0.05)at 3rd,(0.5 ± 1.8 vs 0.1 ± 0.2,P>0.05)at 6th.Patients in the stoma group showed more mild anxiety before the stoma was received,and the difference was statistically significant(P<0.05),the anxiety disappeared after the stoma was restored,there was no anxiety in the unstoma group after the operation.The score of the Health Questionnaire Depression Scale(PHQ-9)was(2.2 ± 1.6 vs 2.5 ± 1.7,P>0.05)at 1st after surgery,(0.6±1.2 vs 0.3 ± 0.7,P>0.05)at 3rd,and at 6th it was(0.2±0.8 vs 0.1 ± 0.3,P>0.05).There was no psychological depression in the two groups of patients after the operation,and there was no statistically significant difference at each follow-up time point(P>0.05).5.The core quality of life scale(QLQ-C30)has a total of 15 domain scores.The physical function domain scores of patients in the stoma group and the unstoma group were(85.1 ± 6.2 vs 80.4 ± 8.5,P<0.05)at 1st after surgery,(98.7 ± 4.7 vs 91.2 ± 7.2,P<0.05)at 3rd;the overall health status score was(67.7± 13.9 vs 56.5± 11.6,P<0.05)at 1st after surgery,and(76.0 ± 14.1 vs 69.6± 9.5,P<0.05)at 3rd,(87.3± 15.8 vs 79.3 ± 11.0,P<0.05)at 6th;Diarrhea area score was(40.0± 30.4 vs 59.5±26.2,P<0.05)at 1st after surgery,(22.7± 30.0 vs 39.6 ± 22.0,P<0.05)at 3rd.The stoma group performed better in the above areas,and the differences were statistically significant(P<0.05).The scores of other areas were compared between the groups at each follow-up time,and there was no statistically significant difference(P>0.05).Conclusion:1.For patients with preventive ileostomy during the laparoscopic radical anus-preserving surgery for middle and low rectal cancer,their bowel control ability after defecation through the anus is better.This suggests that preventive ileostomy can help patients recover better and faster anal function after surgery.2.Preventive ileostomy has no significant effect on the recovery of urination and sexual function in male patients with rectal cancer after anus preservation.3.Preventive ileostomy will not cause depression in the patient,but it will cause mild anxiety in the patient,which disappears after the stoma is accepted.4.Patients undergoing preventive ileostomy have a better quality of life in the short term after surgery.. |
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