To Explore The Role Of Loop Ileostomy In Anus-Preserving Operation Of Middle And Low Rectal Cancer

Objective:To explore the role of loop ileostomy in anus-preserving operation of middle and low rectal cancer Methods:A case-control study was conducted to retrospectively analyze the clinical data of 124 patients with middle and low rectal cancer who underwent laparoscopic anus-preserving surgery in the Affiliated Hospital of Guizhou Medical University from September 2018 to September 2021.Patients who met the inclusion criteria were divided into observation group(stoma group)and control group(non-stoma group)according to whether or not ileal loop stoma was used.The clinical baseline indexes,hospitalization indexes(operation time,intraoperative blood loss,hospitalization time,hospitalization expenses,ASA grade,Dukes stage,tumor histological classification,tumor gross classification),preoperative and postoperative indexes(postoperative exhaust time,postoperative defecation time,postoperative anal canal and drainage tube removal time,postoperative nutrient solution stopping time,hemoglobin,serum total protein,albumin,CEA,potassium ion,sodium)were compared between the two groups.The incidence of anastomotic leakage was compared between the two groups.Meanwhile,the risk factors of anastomotic leakage,stoma-related complications and stoma return time were analyzed.Results:1.A total of 114 patients were included in this study.Among them,57 patients in the observation group completed low anterior resection+ileal loop ostomy and stoma-receiving operation,while 57 patients in the control group only completed low anterior resection.Compared with the control group,the distance between the lower margin of the tumor and the anal margin in the observation group was lower,and the difference was statistically significant(P < 0.05).There was no significant difference between the two groups in gender,age,BMI,basic diseases,defecation habits,hematochezia,history of smoking and drinking,and clinical stage of tumor(P > 0.05).2.Compared with the control group,the operation time of the observation group was longer(258.16 68.68)/(212.35 57.04)min,and the difference was statistically significant(P < 0.05).There was no significant difference between the two groups in hospitalization indexes,such as intraoperative blood loss,hospitalization time,hospitalization expenses,ASA grade,Dukes stage,histological classification of tumor,and gross tumor classification(P > 0.05).3.Compared with the control group,the observation group’s postoperative exhaust time was earlier than that of the control group(2.66 1.49)/(3.63 1.74)d,the postoperative defecation time was earlier than that of the control group(3.841.92)/(5.33 2.31)d,and the postoperative anal canal removal time was earlier than that of the control group(8.49 2.65)/(The time of stopping nutrient solution after operation was earlier than that of the control group(9.19 4.32)/(11.10 5.40)d,the hemoglobin was higher than that of the control group(125.77 21.42)/(114.62 21.79)g/L,and the total protein was higher than that of the control group(58.02 6.75).4.Postoperative anastomotic leakage occurred in 3 patients(5.3%)in the observation group and 15 patients(26.3%)in the control group.The incidence of postoperative anastomotic leakage in the observation group was lower than that in the control group,and the difference was statistically significant(P < 0.05).Another data showed that 16(15.7%)of 102 patients with anastomotic height ≤6cm had anastomotic leakage,and 2(16.7%)of 12 patients with anastomotic height > 6 cm had anastomotic leakage.The incidence of anastomotic leakage in the control group was higher than that in the observation group,and the difference was statistically significant(P < 0.05).There was no significant difference in the treatment of anastomotic leakage between the two groups(P > 0.05).5.Analysis of risk factors of anastomotic leakage: hypertension,albumin lower than 33g/L 3 days after operation,anastomotic height ≤6cm,distance between the lower margin of tumor and anal margin ≤6cm,no ileostomy,and male are the risk factors of anastomotic leakage,which have statistical significance(P < 0.05).6.Complications related to stoma: electrolyte disorder(45 cases of hyponatremia and 22 cases of hypokalemia),in which 1 case was hospitalized due to dizziness and fatigue caused by hyponatremia;Irritative dermatitis was found in 15 cases,and 3cases were readmitted to hospital because of skin itching and ulceration near stoma.16 cases of intestinal obstruction,of which 10 cases were readmitted to hospital,and even 2 cases underwent surgical treatment;10 cases of stoma stenosis;Pelvic abscess and stoma edema in 1 case each;The readmission rate caused by stoma-related complications reached 31.1%,and the reoperation rate reached 14.3%.7.The average return time of ostomy group was(183.82±87.2)d,of which the return rate within 4 months was 29.8%.Conclusions:Application of ileal loop stoma in anus-preserving operation for middle and low rectal cancer can reduce the incidence of postoperative anastomotic leakage.It is suitable for male patients with hypertension,anastomotic height ≤6cm,distance between the lower edge of tumor and anal margin ≤6cm,and malnutrition,at the cost of a series of problems caused by stoma-related complications.