The Impact Of Stapling Anastomosis On The Intestinal Function

Background and Objective:The incidence of colorectal cancer increased year by year, has moved up to No. 3-5. Rectal cancer accounts for about 70%, mainly in the low rectal cancer below peritoneal fold. With the research of biological behavior,lymph node metastasis of the colorectal cancer and application of low anterior resection, double stapling, total mesorectal excision, more and more low even ultra-low rectal cancer patients are treated with Dixon. The patients acquire better quality of life, but still experience disordered defecation after the stapled anastomosis. There are some disadvantages of the technique. Thinking the operations are successful, many clinicians fail to attach importance to the pain of patients due to the bad intestinal function, even ignore this point. Through following up, we investigated the change of intestinal function after colorectal anastomosis with stapling technique, and then analyzed the impact of stapling anastomosis on the intestinal function, and wish the work can provide new ideas for the development of seamless stapler.Methods: 95 patients who received colorectal anastomosis with stapling technique were divided into 3 groups according to the distance between anastomosis and dentate line (ultra-low:<2cm, low:2cm~peritoneum invagination; high: above peritoneum invagination),and were followed up.67 and 30 patients were underwent colonoscopy at 6mo and 1y respectively. They were divided into 3 groups according to the results(A: smooth anastomosis,good enterocinesia;B: circumscribed granuloma on anastomosis;C:stenotic and spastic anastomosis,loss of peristalsis). All the patients'intestinal function was evaluated with Zhong-Fa Xu's evaluation criteria at1month, 3 months, 6 months and 1 year after operation. The one-way ANOVA was used to test the impact of anastomosis level on the recovery of intestinal peristalsis, one-way ANOVA was used to test the factors of time and anastomosis level, chi-square was used to analysis the diarrhea and constipation. P<0.05 indicates significant difference.Results:1. Intestinal function : According to ratings, on the point of 1mo,3mo,6mo and 1y, the excellent ones take about 2.1%,23.2%,32.6%,54.7%;the good ones take about 24.2%,26.3%,36.8%,34.7%;the general ones take about 35.8%,30.5%,27.4%,10.5%;the poor ones take about 37.9%,20.0%,3.2%,0%.2. The recovery of intestinal peristalsis: The average days were 4.62±1.11 days. That of ultra-low group,low group and high group was 4.65±1.027days,4.51±1.075 days and 4.74±1.237 days. There was no significant difference between that of the three groups (F= 0.383, P=0.683).3. Influential factor:①Time The P values of 1mo vs. 3mo,1mo vs.6mo,1mo vs.1y,3mo vs.6mo,3movs.1y and 6mo vs.1y in ultra-low group were 0.000,0.000,0.000,0.002,0.000 and 0.000.That in low group were 0.001,0.000,0.000,0.052,0.000,0.009 ; high group were 0.055,0.000,0.000,0.009,0.000 and 0.020.②Anastomosis level The P values of ultra-low group vs. low group,low group vs. high group and ultra-low group vs. high group at 1mo were 0.007,0.000 and 0.000. That at 3mo were 0.036,0.000,0.000; 6mo were 0.001,0.001,0000,1y were 0.015,0.000 and 0.000. All were statistically significant.4.Alternating diarrhea and constipation:①Time In ultra-low group ,the P values of 1mo vs.6mo,1mo vs.1y,3mo vs.6mo,3movs.1y and 6mo vs.1y were 1.000,0.009,1.0000,0.009 and 0.047,the rates of the phenomenon between 1mo and 3mo were same. The P values of 1mo vs. 3mo,1mo vs.6mo,1mo vs.1y,3mo vs.6mo,3movs.1y and 6mo vs.1y in low group were 0.212,0.001,0.000,0.018,0.000 and 0.001, that in high group were 0.167,0.147,0.011,1.000,0.238 and 0.492.②Anastomosis level The P values of ultra-low group vs. low group,low group vs. high group and ultra-low group vs. high at 1mo were 0.288,0.000 and 0.000, that at 3mo were 0.043,0.000,0.000, 6mo were 0.001,0.001,0000, 1y were 0.015,0.000 and 0.000. All were statistically significant except that of 1mo.5. Colonoscopy results: At 6mo, 4 of 21 patients of A group existed alternating diarrhea and constipation, cases with ultra low and low anastomosis level were half and half;12of 30 patients of B group existed,all of them were with ultra low or low anastomosis level; 15 of 16 patients of C group existed, the other one was with high anastomosis level. At 1y, one patient in ultra-low group of 16 patients of A group exist the phenomenon;6 of14 patients of B group and all 8 patients of C group existed, all of them were with ultra low or low anastomosis level.1. Anastomosis level has no significant effect on the recovery of intestinal peristalsis.2. Patients have varying degrees of dysporia after colorectal anastomosis with stapling technique. It is particularly evident within 6 months. With increased time and anastomotic plane, the intestinal function gradually improved.3. The stapling anastomosis could impact the intestinal movement, the salient clinical manifestations is alternating diarrhea and constipation. The higher anastomosis level, the phenomenon less significant, and vice versa and improve less significantly. The intestinal dysfunction of patients influences their quality of life, the stapling technique need to be improved.