| ObjectiveAnastomotic leakage (AL) is one of the serious complications of low anterior resection of rectal cancer (LAR). If patients aged over 60 years old, male, hypertension, diabetes, tumor TNM stage Ⅲ and Ⅳ, tumor from the anal margin is equal to or less than 7cm, emergency surgery and tumor malignant degree higher risk factors and anastomosis leakage incidence increased significantly and anastomosis leakage significantly increased mortality rate. The traditional prevention of ileum end and transverse colon loop’s fistula surgery is also faces the difficulty of surgery and postoperative anastomotic recurrence of fistula of risk when two stage surgical procedure. The purpose of this study is to discuss the preventive Y type transverse colostomy in risk factors for resection of rectal cancer clinical application value.MethodReview of 447 cases of patients with radical surgery of the Second Affiliated Hospital of Kunming Medical University from October 2013 to October 2015 were rectal cancer, comparative analysis of gender, age, hypertension, diabetes, whether emergency surgery, TNM stage, pathological type, from the anal edge distance of postoperative anastomotic leakage effects. There were 157 patients with high risk factors to be grouped according to the prevention of fistula and different fistula. The incidence rate of anastomotic leakage after prophylactic intestinal fistula and the related research of the two complications were studied.. The 157 cases exist high risk factors in patients with rectal cancer control analysis for preventive transverse Y-shaped fistula (group A, n= 27) (completed by the first ward of Department of gastrointestinal surgery, the Second Affiliated Hospital of Kunming Medical University), prevention of intestinal loop’s fistula (terminal ileum and transverse colon loop’s fistula) (group B, n= 50) and without preventive colostomy (C group)80 cases. A group and B group were compared with the C group of postoperative anastomotic leakage, intestinal ventilation time and postoperative hospital stay. Group A and group B comparing postoperative anastomotic fistula, intestinal ventilation time and postoperative hospital stay, and stoma apothesis on the operation time, bleeding volume, postoperative anastomosis fistula, postoperative ventilation time, infection of incision and postoperative hospital stay. Data are used spss20.0 statistical software analysis.Result1、There were 30 cases of anastomotic leakage in 447 cases, AL occurred in postoperative 3-11 days, mostly occurred in4-8 days (65.4%).Including 23 cases of male,7 female cases, age over 60 years in 22 cases,8 patients were younger than 60 years; 18 cases of diabetic patients,12 cases of patients without diabetes; hypertension in 9 cases,21 patients without hypertension; emergency operation in 9 cases,21 cases of elective surgery; from the dentate line is less than or equal to 7cm in 21 cases, greater than 7 cm in 9 cases; tumor stage T1-T2 14 patients; 16 cases of patients with T3-T4 stage; 23 cases of adenocarcinoma, mucinous carcinoma,5 cases, undifferentiated carcinoma in 2 cases; In accordance with the occurrence of anastomotic leakage group.the statistical variables to do a single factor analysis, the results are shown in Table 1.From related factors analysis showed that the patients with postoperative anastomotic leakage in patients with gender, age, distance to the dentate line distance, tumor TNM stage Ⅲ and Ⅳ, diabetes, whether emergency surgery related factors, and significant difference between two groups has statistical significance (P<0.05). It was not associated with hypertension, preoperative albumin and tumor pathological typing.2、19 cases of anastomotic leakage occurred in 157 patients with high risk factors for rectal cancer after radical operation.There were 1 cases in A group,2 cases in B group,16 cases in C group,A group and B group were compared with C group were statistically significant (P<0.05); A group compared with B group had no significant difference (P>0.05) (see Table 2);Intestinal ventilation time A group was 2.85±0.72 days, B group was 3±0.98 days, C group was 3.12±1.06 days;Postoperative hospital stay in group A was 9.96±1.68 days, B group was 9.74±1.81 days, C group was 12.45±5.31 days;A, B two groups were compared with the C group of intestinal ventilation time and postoperative hospital stay were statistically significant (P<0.05) (see Table 3).3、A total of 5 patients with anastomotic leakage occurred in 77 patients who were treated with prophylactic stoma, including 1 cases in A group,4 cases in B group, The results of the two groups were not statistically significant (P>0.05) (see Table 4); The time of opening the fistula was satisfied A group is 52.96±10.22 min, B group is 86.04±14.73min, The amount of bleeding in the A group was 40.74±8.05ml, and the B group was 80.40±13.09ml; There was significant difference between the two groups in operation time and blood loss during operation (P<0.05);Intestinal ventilation time A group was 1.31±0.49 days, B group was 2.30±0.51 days.Postoperative hospital stay in group A was 5.41±1.05 days, B group was 7.48±1.05 days. The two groups of intestinal ventilation time and postoperative hospital stay were statistically significant (P<0.05) (see Table 5).ConclusionThere is a high risk factor (male, age over 60 years, anal tumor<7cm, combined with diabetes and tumor TNM stage Ⅲ-Ⅳ, emergency surgery) of rectal cancer patients who underwent preserving anus operation choice of preventive Y type transverse colostomy can not only effectively reduce the technique the fistula incidence and anastomosis leakage complications related to the incidence of anastomotic, and can effectively reduce the phase Ⅱ fistula to difficulty of surgery and postoperative complications related to the incidence. |
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