| Objective:To explore the effects of different surgical methods on postoperative quality of life,defecation function and sexual function of patients with low rectal cancer,as well as the feasibility and clinical efficacy of preventive terminal ileal stomy in anus preservation surgery for low and middle rectal cancer.Methods: From January 2020 to March 2022,a total of 113 patients with low rectal cancer treated by laparoscopic surgical approach in our hospital were divided into group A: laparoscopic Dixon group,group B: laparoscopic Dixon + prophylactic stoma group,group C: laparoscopic Miles group,and group D: laparoscopic Hartmann group according to the surgical approach,using the SF-36 quality of life scale,the Wexner Fecal Incontinence Score,International Index of Erectile Function scale(IIEF-5),CIPE(ejaculatory function scale),and Female Sexual Function Index(FSFI)scale to determine the patients’ quality of life,anal function,and sexual function at different time points after surgery for assessment.The mean operative time,intraoperative bleeding,time to first postoperative venting,time to first postoperative bed release,postoperative hospital stay,and the occurrence of postoperative complications were also compared between the patients in groups A and B.Results: Patients in group A had higher scores for somatic pain than group B at 1 month and 3 months postoperatively(P<0.05),and patients in group A had higher scores for social vitality than group B at about 1 month postoperatively(P<0.05),and patients in group B had higher scores for social vitality than group A at about 3 months postoperatively(P<0.05).In terms of social functioning,group A had a higher score than group B at 1 month postoperatively(P<0.05),and patients in group B had a higher score than group A at 6 months postoperatively(P<0.05).patients in group A had a higher overall mental health score than group B at 1 month postoperatively(P<0.05).patients in group A had a higher score for somatic pain at 1 month postoperatively and at 3 months postoperatively than group C(P<0.05).At 1 month postoperatively,patients in group A had higher social vitality and social function than group C(P<0.05).At 1month postoperatively,patients in group A had a higher overall mental health score than group C(P<0.05).At 6 months postoperatively,there was no significant difference in the comparison of postoperative quality of life between groups A and C(P>0.05).At 1month,3 months and 6 months after surgery,there was no significant difference in the comparison of quality of life between groups C and D(P>0.05).In January and March after surgery,the Wexner scores of patients in group B were lower than those in group A(P<0.05);in January,March and June after surgery,there was no significant difference in erectile function between patients in groups A and B(P>0.05),the erectile function of men in groups A and B was better than those in groups C and D,(P<0.05),and no significant difference in erectile function between patients in groups C and D(P>0.05);at 1 month,3 months and 6 months after surgery,there was no significant difference in ejaculatory function between patients in groups A and B(P>0.05),and no significant difference in ejaculatory function between patients in groups C and D(P>0.05),but ejaculatory function was better in groups A and B than in groups C and D(P<0.05).At1 month,3 months and 6 months after surgery,there was no statistically significant difference in sexual function between female patients in groups A and B(P>0.05),and there was no significant difference in sexual function between female patients in groups C and D(P>0.05),but the sexual function of women in groups A and B was better than that in groups C and D(P<0.05).Conclusion: The quality of life of patients with low rectal cancer improved gradually over 6 months after surgery.The stoma had a greater impact on the quality of life of patients 1 to 3 months after surgery,and the quality of life of patients improved significantly after prophylactic stoma return.The quality of life of patients with a permanent stoma was not significantly different from that of patients with preserved anal function after 6 months,and there was no significant difference in quality of life between the Miles procedure and the Hartmann procedure for patients in the two groups,as long as the patients were physically able to tolerate it.The prophylactic stoma improved patients’ short-term postoperative bowel symptoms.Patients with preserved anal function had better postoperative sexual function.The prophylactic stoma did not reduce the incidence of postoperative complications,but was beneficial to the patient’s postoperative recovery. |
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