Clinical Study Of Preventive Stoma In Radical Resection Of Rectal Cancer In Elderly Patients

BackgroundRectal cancer is a common malignant tumor of the digestive system.The incidence rate in China has risen to the third place,and the proportion of low rectal cancer is higher.Due to the continuous innovation of surgical equipment,advancement of anastomosis techniques and the implementation of neoadjuvant radiotherapy and chemotherapy,minimally invasive surgery for low rectal cancer following laparoscopic TME has significantly improved the rate of anal sphincter preservation,but at the same time increased the incidence of postoperative anastomotic leakage rate.At present,with the intensification of aging in China,the proportion of elderly patients with low rectal cancer is large,and with the gradual weakening of organ function,the tolerance to surgical trauma during perioperative period is gradually reduced.Prevention of anastomotic leakage has been the topic of our discussion.This study explores the significance of preventive ostomy in the treatment of elderly patients with low rectal cancer.ObjectiveTo explore the clinical value of preventive stoma in radical resection of rectal cancer in elderly patientsMethodsA total of 76 elderly patients admitted to the Department of General Surgery of Nanyang Central Hospital with low rectal cancer who underwent laparoscopic TME as a surgical procedure from June 2015 to June 2018 were enrolled in this study.Retrospective analysis was performed according to the presence or absence of preventive stoma.For the observation group and the control group,the observation group was given preventive ostomy(40 cases),and the control group did not perform preventive ostomy(36 cases).The clinical data of the two groups were analyzed.The age,gender,pathological differentiation,TNM stage,hospitalization time,first exhaust time,anastomotic leakage rate,anastomotic stenosis rate,SF-36 value,perioperative peripheral blood mean CRP value were compared between the two groups.The difference in the values of the level,the PCT value of the peripheral blood,and the number of lymphocytes.Results1.There were no significant differences in age,gender,pathological differentiation and TNM staging between the observation group and the control group(P>0.05).2.Postoperatively,the incidence of anastomotic leakage and stenosis in the observation group was lower than that in the control group(P?0.05).3.The hospital stay(14.03±2.63)d was significantly shorter in the observation group than in the control group(16.08±3.59)d,and the difference was statistically significant(P?0.05).The first exhaust time(2.73±0.78)d was significantly shorter in the observation group than in the control group(3.44±0.94)d,and the difference was statistically significant(P?0.05).4.The preoperative CRP level,PCT level and lymphocyte count of the observation group and the control group were(7.20±1.27)mg/L and(7.27±1.36)mg/L,(0.09±0.04)ng/ml and(0.08±0.04)ng/ml,(2.18±0.42)×10~9/L and(2.16±0.41)×10~9/L,The CRP level in the peripheral blood of the observation group was(14.84±2.21)mg/L on the 7th day after operation,which was significantly lower than that in the control group(32.85±3.62)mg/L.The PCT level on the 5th day after operation was(0.14±0.02).)ng/ml was significantly lower than the control group(0.55±0.17)ng/ml.The number of peripheral blood lymphocytes in the observation group on the 7th day after surgery was(1.84±0.35)×10~9/L significantly more than the control group(1.56±0.33).)×10~9/L,the difference was statistically significant(P<0.01).6.The quality of life(SF-36 value)at the sixth month after surgery in the observation group and the control group(50.89±4.98)and(39.04±5.98)were statistically significant(P?0.05).Conclusion1.The implementation of preventive ostomy can reduce the incidence of anastomotic leakage and the incidence of anastomotic stenosis after surgery in elderly patients with low rectal cancer.2.The implementation of preventive ostomy can reduce the inflammatory stress response and reduce the nutritional risk in elderly patients with low rectal cancer.3.The implementation of preventive ostomy can shorten the first exhaust time,hospitalization time and improve the quality of life of elderly patients with low rectal cancer.