Effects Of Two Opening Methods Of Prophylactic Ileostomy On Recent Clinical Outcome In Low Rectal Cancer Patients After Anus-saving Operation

Objective:To compare and discuss the effects of stage I opening and stage II opening of prophylactic ileostomy on recent clinical outcome in low rectal cancer patients.Methods:The prospective study was conducted.Eighty-nine low rectal cancer patients who accepted low anterior resection and prophylactic terminal ileostomy in the gastrointestinal surgery department of the Affiliated Hospital of Qingdao University from December 2016 to May 2017 were enrolled.They were assigned into experimental group and control group in accordance with the random number table,with 45 patients in the experimental group,accepting intraoperative stage I stomaopening;with 44 patients in the control group,accepting postoperative stage II stomaopening.The postoperative recovery,incidence of complications,stress response,immune function index and quality of life of patients in the two groups were compared.Results:The operation time of the experimental group was longer than that of the control group([(115.5±11.2)min versus(108.9±10.9)min,t=2.765,P>0.05]),and the difference was not statistically significant;the postoperative fever time([(54.4±6.5)h versus(63.9±5.8)h,t=7.219,P<0.05]),postoperative hospitalization time([(6.7±1.2)d versus(7.3±1.0)d,t=2.790,P<0.05])and hospitalization cost([(52269.2±2887.8)yuan versus(58419.3±2898.1)yuan,t=11.844,P<0.05])of patients in the experimental group were significantly lower than those in the control group,and the differences were statistically significant;when being discharged,the quality of life score of patients in the experimental group was significantly higher than that in the control group([(19.9±1.2)versus(17.6±1.0),t=10.025,P<0.05]),and the difference was statistically significant;the total incidence of ileostomy-related complications[24.4%(11/45)versus 29.5%(13/44),X~2=0.294,P>0.05]and the total incidence of system complications[20.0%(9/45)versus 20.5%(9/44),X~2=0.003,P>0.05]in the experimental group were lower than that in the control group,but the difference were not statistically significant;the C-reactive protein(CRP),TNF-?,IL-6 of patients in the experimental group on day 3 and day 5 after operation were significantly lower than those in the control group,and the differences were all statistically significant(F=2.871~39.314,P<0.05).The IgA and IgG level of patients in the stage I opening group on day 3 after operation were significantly higher than those in the stage II opening group,and the differences were all statistically significant(F=2.115~2.341,P<0.05);CD4~+,CD4~+/CD8~+,IgA,IgM and IgG of patients in the stage I opening group on day 7 after operation were significantly higher than those in the stage II opening group,and the differences were all statistically significant(F=2.403~4.046,P<0.05).The influence of time factor on immune function did not change with opening of stoma(F=20.769~151.608,P<0.05).Conclusion:Stage I opening of prophylactic ileostomy is safe and effective,which can reduce postoperative stress response,protect patients'immune function and promote patients' rehabilitation.