Clinical Observation Of Early Non-Surgical Intervention To Reduce The Surgical Shunt Rate Of Anastomotic Leakage After Laparoscopic Low Anterior Resection Of Rectal Cancer

Objective: To investigate whether early non-surgical intervention can reduce the surgical shunt rate of anastomotic leakage after laparoscopic anterior low resection for rectal cancer.Methods: Retrospective analysis from January 2016 to June 2018 in Gastrointestinal Surgery Department of Affiliated Hospital of Zun Yi Medical University parallel underwent laparoscopic resection of low rectal gastrointestinal surgical diagnosis of rectal cancer patients,according to include and exclude standard screening cases,to include the analysis of the cases in treatment group for the treatment of postoperative anastomotic leakage suspicious of concept is different,divided into early non-surgical intervention group and conventional treatment group.early non-surgical intervention group carried out early non-surgical intervention for patients with suspicious anastomotic leakage.In conventional treatment group,routine treatment+symptomatic treatment were given to patients with suspicious anastomotic leakage,and routine treatment was given to patients without suspicious anastomotic leakage in the two groups.The two groups of patients were analyzed as follows:(1)Between the two groups,analyze the difference of the occurring time of suspected anastomotic leakage.(2)In order to determine whether the two groups could be comparable,several differences between the two groups were analyzed,mainly containing the differences in preoperative complications,gender,age,BMI,ASA grade,distance between tumor and anal margin,tumor TNM stage,tumor size,operation time,intraoperative blood loss and other aspects.(3)The outcome of suspicious anastomotic leakage(no leakage?graded B leakage and graded C leakage)and the operative rate were compared between the two groups.Results:A total of 48 cases of suspicious anastomotic leakage were found among the patients who completed laparoscopic anterior low resection for rectal cancer in this period of time:(1)Among them,there were 21 patients with suspected anastomotic leakage in the early non-surgical intervention group and 27 patients with suspected anastomotic leakage in the conventional treatment group.The occurrence time of suspected anastomotic leakage was(3.90±1.04)d vs(4.00±1.21)d(P>0.05),and the difference between the two groups was not statistically significant.(2)There was no significant difference between the two groups in preoperative complications,gender,age,BMI,ASA grade,tumor distance from the anal margin,tumor TNM stage,tumor size(5.33±1.39)cm vs(5.07±1.14)cm,operative time(187.05±12.10)min vs(190.22±19.24)min,intraoperative blood loss(22.62±9.44)ml vs(21.67±13.16)ml(P>0.05).Thereby,it can be concluded that the two groups were comparable.(3)The two group patients with suspicious anastomotic leakage after different treatments,the no leakage,grade B leakage and grade C leakage had 6 cases,12 cases and 3 cases in the early non-surgical intervention group;There were 4 cases,8 cases and 15 cases in the conventional treatment group,and no leakage and grade B leakage patients in the two groups showed no statistical significance(P>0.05).Grade C leakage in the early non-surgical intervention group was significantly less than that in the conventional treatment group(P<0.05).Grade C leakage patients in both groups were treated with fecal shunt,and the shunt rate of patients in the two groups was 14.29% vs 55.56%.The shunt rate in the early non-surgical intervention group was significantly lower than that in the conventional treatment group(P<0.05),and the shunt operation time in two group were(7.67±2.36)days and(6.93±1.62)days,respectively.The difference between the two groups was not statistically significant(P>0.05).Two groups of patients with suspected anastomotic leakage after treatment were discharged from the rehabilitation,no death cases;The postoperative hospitalization time in two group were(24.81±4.01)days and(22.37±5.39)days,respectively,and the difference was not statistically significant(P>0.05).Conclusion: Early non-surgical intervention can reduce the operative diversion rate of patients with suspected anastomotic leakage after laparoscopic anterior resection for rectal cancer.