| Background:Enhanced Recovery After Surgery was first applied in colorectal surgery in China and achieved a series of good clinical results.However,the morbidity of rectal cancer continues to increase year by year,and it has now become one of the major cancers affecting human health.At present,the main treatment for rectal cancer is surgery and the most serious complication after surgery is anastomotic leakage,and result in series of symptoms such as severe abdominal pelvic infection and water-electrolyte disorder which increases duration of hospital stay and hospital costs.Some scholars have suggested that protective stoma can be used to reduce the morbidity of anastomotic leakage after anterior resection of rectal cancer.However,protective stoma requires secondary surgery,result in complicatio ns such as stomatitis,parastomal hernia,and difficult to nurse,reduce the quality of life.And there are different views on the use of protective stoma in clinical practice,its clinical application is hindered.Objective:The purpose of this study was to investigate the treatment effect of da Vimce robotic middle and low anterior resection of rectal cancer with protective ileostomy,and to evaluate the safety and efficacy of protective ileostomy in da Vince robotic middle and low anterior resection of rectal cancer with enhanced recovery after surgery.Methods:The clinical data of 115 patients who received da Vince robotic middle and low anterior resection of rectal cancer in General Surgery Department of Nanjing General Hospital of the PLA from January 2011 to June 2015 were retrospectively analyzed.The criteria for enrollment were rectal cancer and tumor located 2 to 10 cm from the anus confirmed by colonoscopy and pathology,no distant metastasis by image examination,and have an elective da Vince robotic anterior resection of rectal cancer surgery;excluded criteria:palliative surgery,Open surgery,emergency surgery,and patients with severe cardiovascular and cerebrovascular diseases.All patients were treated according to the enhanced recovery after surgery program and with da Vince robotic anterior resection of rectal cancer surgery,patients were divided into two groups based on whether received protective ileostomy,60 patients were in stoma group,and 55 patients were in non-stoma group.Operation time,blood loss,the time of first flatus,the time to liquid diet intake,postoperative hospital stay,the time of first chemotherapy after surgery and complication were assessed in two groups.Results:1.The operation time of the two groups were(180.8±15.8)min and(155.6±17.3)min respectively;the time of first flatus were(22.4±6.9)hand(48.5±14.8)h respectively;the time to first liquid diet intake were(19.2±9.3)h and(40.0±15.2)h respectively;the days of postoperative hospital stay were(5.5±1.9)days and(7.9± 2.9)days respectively;the time of first chemotherapy after surgery were(15.1 ±6.6)days and(20.9±7.8)days;the blood loss was(52.7±15.7)ml and(50.4±13.7)ml respectively;it suggested that the stoma group have the time of first flatus,the time to first liquid diet intake,and the days of postoperative hospital stay were shortened(P<0.05),the operation time was prolonged(P<0.05),the time of first chemotherapy after surgery was advanced(P<0.05),and there were no significant differences in blood loss among 2 groups(P>0.05).2.The mortality rate of anastomotic leakage in the two groups were 0 and 7.3%,and the total complications rate were 16.7%and 14.5%,respectively,suggesting that the mortality rate of anastomotic leakage in the stoma group decreased(P=0.049<0.05),and there were no significant differences in total complications rate among 2 groups(P>0.05).Conclusion:When combined enhanced recovery after surgery with da Vince robotic in middle and low anterior resection of rectal cancer,protective ileostomy have more significant efficacy and safety than non-stoma group.And in the consideration of protective ileostomy need to secondary surgery and complications of stoma,surgeons should grasp the indications of stoma and routinely perform protective ileostomy for high-risk patients with advanced age,low tumor location,severe basic disease,neoadjuvant therapy and et al. |
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