| BackgroundColorectal cancer(CRC)is a common malignant tumor of digestive tract in China.Rectal ca,ncer plays an important role in the incidence of colorectal cancer in China,and one of the important characteristics of rectal cancer in China is that the majority of patients with low rectal cancer among the patients of rectal cancer.At present,radical surgery is still the first choice for patients with rectal cancer,and postoperative anastomotic leakage has been a common and serious complication for patients with middle or low rectal cancer.Clinically,in order to reduce the occurrence of postoperative anastomotic leakage and avoid serious complications and even death caused by anastonmotic leakage,radical total mesoreclal excision of rectal cancer is not only performed.the patients with lhigh risk factors of anastomotic leakage are also usually needed to perform protective ileostomy.However,the diversion colitis caused by enterostomy has become a clinical problem that should not be ignored.However,the pathogenesis of-diversion colitis is not clear at present,and at present,colonoscopy is still the main diagnostic method for diversion colitis in clinically.But,owing to the division of internal and surgical departments in Chinese hospitals,colonoscopy is usually carried out by physicians.Thus,it is difficult for physicians to follow up surgical patients with diversion colitis,but colorectal surgeons are obviously not aware of the colonoscopy manifestations and severity of diverted colitis,thus ignoring this kind of problems in clinical practice.In addition,the current treatments of cdiversion colitis have not been well solved in clinically,because of the lack of recognized treatment criteria,the treatments of diversion colitis are very mixed,and the therapeutic effect is not clear and needs to be confirmed.In addition,there are no SCFA drugs for the treatment of DC patients,which results the current situation of DC patients in a drug-free situation.Therefore,the treatment of diversion colitis has not been well solved in clinically,and it is urgent to explore a safe and effective clinical treatment method that is easy to obtain,easy to operate and safe to treat.Object1.To investigate the occurrence,clinical manifestations,colonoscopy features,CD immune function and the relationship between colonoscopy findings and symptoms to improve the clinical surgeons' understanding of diversion colitis.2.To explore a safe,effective and practical method for the treatment of diverted colitis,so as to provide a reference for the clinical treatment of diversion colitis.MethodPart 1 Analysis of diversion colitis caused by intestinal stoma in rectal cancer.The patients were selected according to the criteria of inclusion and exclusion.Finally,89 patients with rectal cancer fistula were included in the fistula group and 375 patients without fistula were included in the non-fistula group.The clinical symptoms,the characteristics of colonoscopy,the immune function of CD were compared and analyzed retrospectively between the patients of two groups,and analyzed the relationship between the manifestations of colonoscopy and symptomsPart 2 Efficacy and safety of enteral nutrition combined with probiotics in treatment of diversion colitis.Accoirding to the inclusion criteria and exclusion criteria,43 patients were selected finally,including 20 patients in the treatment group and 23 patients in the control group.The patients of treatment group were treated with enteral nutrition emulsion(RuiNeng)combined with bifidobacterium quadruple live bacteria(SiLianKang)enema,while the patients of control group were treated with the same amount of normal saline enema.At the end of a course of treatment,colonic inflammation under colonoscopy,colonic mucosal inflammation under light microscope,liver and kidiney function and adverse reactions were compared between the patients of two groups.ResultPart 1 Analysis of diversion colitis caused by intestinal stoma in rectal cancer.1.Among 89 patients in the fistula group,30 patients had cliinical symptoms related to diversion colitis,in the fistula group.The clinical symptoms of abdominal pain,anal mucus defecation and mucous bloody stool in anal cavity were significantly higher than those in non-fistula group(14.6%vs 2.9%,23.6%vs 5.,1%,12.4%vs 1.9%),the difference was statistically significant(P<0.05).2.In the fistula group,erythema swelling,mucosal erosion ulcer,inflammatory follicular hyperplasia,inflammatory polyp and anastomotic stenosis were detected with colonoscopy.And the positive rate of erythema swelling,mucosal erosion ulcer,inflammatory follicular hyperplasia,inflammatory polyp and anastomotic stenosis were higher in the segment of disused of colon than the patients in the non-fistula group(93.3%vs 14.1%,29.2%vs 7.5%,15.7%vs 0.5%,29.2%vs 6.7%,15.7%vs 4.5%),the difference was statistically significant(P<0.05).3.The absolute counts of T lymphocytes iin peripheral blood of fistula group were CD3+(980±475)/?1,CD4+(550±243)/?1,CD8+(342±206)/?1 and CD4+/CD8+ ratio(1.94±1.44).There was no significant difference between the fistula group with non-fistula group(P>0.05).4.Erosion,ulcer and anastomotic stenosis of colonic mucosa were related to the symptoms of diverted colitis(P<0.05),but there was no significant relationship between the changes of colonoscopy and erythema swelling,inflammatory follicular hyperplasia,inflammatory polyps(P>0.05).Part 2 Efficacy and safety of enteral nutrition combined with probiotics in treatment of diversion colitis.1.Under colonoscopy,there was no significant difference in the score of mucosal injury between the treatment group and the control group before treatment(3.45 ±1.317 vs 4.13?1.254,P?0.090).After treatment completed,the score of mucosal injury under colonoscopy in the treatment group was significantly lower than that in the control group.The ditfference was statistically significant(1.55 ±0.825 vs 3.96±1.0(65,P<0.05).2.Under light microscope,there was no signicant difference in mucosal pathological tissue inflammation score between the treatment group and the control group before treatment(4.60±1.231 vs 4.91 ±1.041,P ? 0.371).Atfter treatment,the inflammation score of mucosal pathological tissue in the treatment group was significantly lower than that in the control group.The difference was statistically significant(2.30±1.081 vs4.43 ±1.037,P<0.01).3.There was no significant difference in liver and kidney function indexes including ALT,AST,Cr and BUN between the treatment group and the control group during before to after treatment(P<0.05).No other adverse reactions were detected except tor 2 patients with mild abdominal discomfort.Conclusion1.Diversion colitis has a high incidence after enterostomy among the patients with rectal cancer.The clinical symptoms of diversion colitis include abdominal pain,mucus and mucous bloody stool.Under colonoscopy,erythema swelling,erosive ulcer,inflammatory follicular hyperplasia,inflammatory polyp,anastomotic stenosis,and mucosal tear caused by inflation coulcd be observed in the disused colonic mucosa.Endoscopic examination is helpful to the early clinicai diagnosis of the disease in order to obtain early symptomatic treatment for those patients.2.Enteral nutrition emulsioin combined with probiotics enema is an eff'ective and safe treatment for DC.which can safely and effectively improve the colonic inflammation of diverted colitis,and has strong clinical maneuverability.It is worthy of further clinical study and reference for clinicians. |
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