Analysis Of The Curative Effect Of Laparoscopy-controlled Abdominoperineal Excision In Patients With Low Rectal Cancer

Objective: Prone jackknife position and Lithotomy position are routinely used for laparoscopy-controlled abdominoperineal excision.This study to comparise the curative effect between prone jackknife position laparoscopic abdominoperineal excision and lithotomy position laparoscopic abdominoperineal excision for low rectal cancer in order to confire which position will provid more benefits to patiens.Methods: Patients with low rectal cancer were selected as research object,who received operation of laparoscopy-controlled abdominoperineal excision during the period from December,2012 to December,2017 from the First Affiliated Hospital of Dalian Medical University.Informations of two groups of patients were collected and recorded,including pre-operative general information(sex,age,neoplasm staging,distance from cancer bottom to dentate line),intra-operative condition(duration of operation,bleeding,transfusion),and post-operative effect(the time of liquid diet,time of semi-liquid diet,post-operative length of stay,the time to remove pelvic drainage tube,post-operative complications).Make use of statistical method to analyze curative effect with the help of those information above-mentioned.We have collected 86 cases of patients with low rectal cancer as research object,received operation of laparoscopy-controlled abdominoperineal excision during the period from December,2012 to December,2017,3 cases of post-operative recurrence of rectal cancer,3 cases with pre-operative neo-adjuvant chemotherapy,1 case of combined inflammatory bowel disease,1 case with post-operative partial hepatectomy,and 1 case of post-operative ileus are exclusive.Result: The rest of the 74 cases of eligible patients with low rectal cancer are involved in this research,including 53 cases of prone jackknife position and 21 cases of lithotomy position.Patients of Prone jackknife position is composed of 33 male cases(62.30%)and 20 female cases(37.70%),with the average age of 65.25±10.19 years old.Patients of lithotomy position is composed of 12 male cases(57.10%)and 9 female cases(42.90%),with the average age of 59.90±12.40 years old.All patients shall be definitely diagnosed through colonoscopy,and defined neoplasm staging by contrast-enhanced CT or pelvic MRI.Under compassion,operation duration of Prone jackknife position group is(3.82±1.66h),while that of lithotomy position group is(4.93±1.89h)with P<0.05,operation duration of Prone jackknife position group is shorter;bleeding amount of Prone jackknife position group is(66.24±40.97ml)and that of lithotomy position group is(78.57±22.14ml),with P=0.023,the average bleeding amount of Prone jackknife position group is less than that of lithotomy position group;with regard of blood transfusion,there are 7 cases need blood transfusion of lithotomy position group(33.3%)and 4 cases need blood transfusion of Prone jackknife position group.In terms of tumor size,distance from cancer bottom to dentate line,pathological type,P value >0.05 without exception and differences.There is no statistical significance in respect of recovery time of intestinal function,time of semi-liquid diet,the time to remove pelvic drainage tube,complication rate of both position groups.In Prone jackknife position group,there are two different ways:to deal with the perineum part first or to deal with the abdominal part first.Patients of dealing with the perineum part first is composed of 22 male cases(68.75%)and 10 female cases(31.25%),with the average age of 54.75±8.49 years old.Patients of dealing with the abdominal part first is composed of 12 male cases(57.10%)and 9 female cases(42.90%),with the average age of 51.50±12.35 years old.In terms of tumor size,distance from cancer bottom to dentate line,pathological type,P value >0.05 without exception and differences.There is no statistical significance in respect of recovery time of intestinal function,time of semi-liquid diet,the time to remove pelvic drainage tube,complication rate of both groups.Conclusions : The prone jackknife position of laparoscopy-controlled abdominoperineal excision for low rectal cancer provided less operation time and bleeding compare to lithotomy position.However,There were no difference in respect of recovery time of intestinal function,time of semi-liquid diet,the time to remove pelvic drainage tube,complication rate of both position groups.In Prone jackknife position group,to deal with the perineum part first or to deal with the abdominal part first.There is no statistical significance in respect of recovery time of intestinal function,time of semi-liquid diet,the time to remove pelvic drainage tube,complication rate of both groups.