Effect Of Terminal Ileum Stoma For Elderly Patients In Surgery Of Middle And Low Rectal Cancer

Objective To evaluate terminal ileum stoma for elderly patients in sphincter-saving laparoscopic surgery of middle and low rectal cancer by comparative study.Methods Retrospective analysis was conducted in the clinical date of 58 middle and low rectal cancer of elderly patients from Dalian Medical University Second Affiliated Hospital of Gastrointestinal surgery from May 2015 to July 2017.Among 58 patients with sphincter-saving laparoscopic surgery of middle and low rectal cancer,28 patients defined as ileostomy group that received terminal ileum stoma and 30 patients defined as non-ileostomy group that not received terminal ileum stoma.The data of patients included age,gender,body mass index,tumor diameter,tumor stage ratio,the distance between the lower edge of tumor and the anal margin,preoperative serum total protein value,albumin value,prealbumin value,operation time,blood loss,hospital costs,serum total protein value,albumin value,prealbumin value on the first postoperative day,serum total protein value and albumin value on the 3-5th postoperative day,postoperative intravenous infusion of albumin and postoperative complications.Statistical analysis of data used SPSS18.0 statistical software.All data were analyzed using t text,chi-square text or Fisher exact test.Results There were no significant differences between the ileostomy group and non-ileostomy group in age,gender,body mass index,tumor diameter,tumor stage ratio,the distance between the lower edge of tumor and the anal margin,preoperative serum total protein value,albumin value,prealbumin value,operation time and blood loss,hospital costs,serum total protein value,albumin value,prealbumin value on the first postoperative day,serum total protein value and albumin value on the 3-5th postoperative day,incidence of anastomotic fistula and electrolyte disturbance andinfection of incisional wound and other postoperative complications(P>0.05).The time of first feeding after ileostomy group and non-ileostomy group were(1.82 ± 0.86)days and(2.47 ± 1.07)days respectively.The statistical analysis showed that the time of first feeding was significant difference between the two groups(P=0.015).The postoperative hospital stay was(8.32 ± 2.77)days and(9.90 ± 2.80)days respectively in the ileostomy group and the non-ileostomy group.The statistical analysis showed that the postoperative hospital stay was statistically significant(P=0.036).The postoperative intravenous albumin supplementation was(18.57 ± 29.28)g and(46.07 ± 58.54)g respectively in the ileostomy group and the non-ileostomy group.Statistical analysis showed that the postoperative intravenous albumin supplementation was significant difference(P = 0.029).The incidence of postoperative ileus in the ileostomy group and the non-ileostomy group was 17.9%(5 cases / 28 cases),0% respectively.The incidence of postoperative intestinal obstruction was statistically analyzed(P = 0.021).There were 6 cases of grade A,1 case of grade B,0 case of grade C in the ileostomy group,and there were 1 case of grade A,5 cases of grade B and 5 cases of grade C in the non-ileostomy group.The statistical analysis showed that the two groups in the severity of anastomotic leakage grading was significant difference(P = 0.014).Conclusion This study showed that terminal ileum stoma for elderly patients in sphincter-saving laparoscopic surgery of middle and low rectal cancer helps the recovery of patient,and reduce the anastomotic leakage of grade reduce the clinical symptoms of anastomotic fistula.