| Background:Carcinoma of the rectum is a common tumor in the gastrointestinal tract.In recent years,the incidence rate in China has increased significantly,which has seriously endangered people's lives and physical and mental health.Most of rectal cancer can be touched during digital rectal examination.The main treatment methods include surgical treatment,radiotherapy,chemotherapy and traditional Chinese medicine treatment.With the maturity and progress of laparoscopic surgery technology,laparoscopic assisted radical surgery for rectal cancer has been widely used in large medical centers in China.Similar to open radical surgery for rectal cancer,laparoscopic radical surgery for rectal cancer also destroys the anatomical structure of the pelvic floor,resulting in pelvic peritoneal defects,and faces risks of intestinal adhesions and intestinal obstruction after surgery.Reconstruction of the pelvic floor peritoneum can prevent diffuse peritonitis in the abdominal cavity due to the formation of infections,abscesses,and anastomotic fistulas due to excessive presacral space and easy effusion.Intestinal perforation,intestinal fistula.It has been reported in the literature at home and abroad that the postoperative recovery may be related to the patient's age,nutritional status,presence or absence of underlying disease,tumor location,tumor size,etc.,and the best way to repair the pelvic peritoneum after surgery has not been consistently In conclusion,the current commonly used methods include direct suture,omentum packing,and application of patches.Biological patches have been widely used in pelvic floor peritoneal repair in recent years,and have good histocompatibility,especially in preventing postoperative intestinal obstruction.In recent years,we have applied biological patches to improve pelvic floor peritoneum The repair has achieved certain results.Purpose:Through a retrospective analysis,the difference between the effect of using biological patch for modified pelvic peritoneal repair and non-pelvic peritoneal repair in laparoscopic radical surgery for rectal cancer was compared,and the application of biological patch for preventing intestinal root obstruction after radical surgery Evaluation of the value of this method.Subjects and methods:A total of 69 patients undergoing laparoscopic-assisted low-level anterior resection of rectal cancer in the Department of Gastrointestinal Surgery of the Provincial Hospital Affiliated to Shandong University from January 1,2016 to December 31,2018 were collected.Inclusion criteria:the patient's preoperative electronic colonoscopy and pathological results suggest rectal adenocarcinoma;KPS score ? 80 points;scheduled surgery can be arranged,there is no history of abdominal surgery and intestinal obstruction before surgery;preoperative examination found no other organ metastasis;age Between 40 and 80 years old;no malnutrition and more serious chronic diseases before surgery.Exclusion criteria:Intraoperative conversion to open;final partial resection of the operation;preoperative anesthesia evaluation AS A grade>III;those with distant metastasis during intraoperative exploration;patients with intestinal obstruction symptoms before surgery;postoperative pathological prompts for other types of tumors Or those with postoperative TNM staging of stage IV;those undergoing secondary surgery due to other diseases after surgery;those who lost follow-up after surgery.The operation was performed by the same operator,and laparoscopically assisted low-level anterior resection of rectal cancer was performed during the operation.According to whether or not the biological patch was used for modified pelvic peritoneal repair,it was divided into:experimental group(35 cases)and control group(34 cases).The indexes of postoperative hospital stay,postoperative anal ventilation time,abdominal infection,anastomotic leakage,and postoperative intestinal obstruction within 1 year after follow-up were compared.Diagnostic criteria for intestinal obstruction within 1 year after surgery:meet the symptoms and signs,imaging findings,and require medical intervention such as fasting,infusion therapy,and secondary surgery.Results:1.There were 0 cases of intestinal obstruction within 1 year after operation in the experimental group,and 4 cases of intestinal obstruction within 1 year after operation in the control group(P<0.05).Among them,3 cases required secondary hospitalization,accounting for 75%.2.The hospital stay in the experimental group was 7.543 ± 1.314 days,and the hospital stay in the control group was 8.971±1.784 days,with statistical difference(P<0.01).3.The operation time of the experimental group was 185.2571±12.88945 min,and the operation time of the control group was 179.6471±17.54454 min,there was no statistical difference(P>0.05).4.The postoperative anal ventilation time of the experimental group was 3.286±0.8935 days,and the postoperative anal ventilation time of the control group was 3.294±0.6291 days,with no statistical difference(P>0.05).There was 1 case of anastomotic leakage in the experimental group and 1 case in the control group after operation,with no statistical difference(P>0.05).There was 1 case of abdominal infection in the experimental group after operation,and 1 case of abdominal infection in the control group after operation,with no statistical difference(P>0.05).Conclusion:1.The use of biological patches for improved pelvic floor peritoneal repair compared with no pelvic floor peritoneal repair in the laparoscopic assisted radical surgery of rectal cancer significantly reduced the incidence of intestinal obstruction within 1 year after operation,effectively reducing patients' postoperative intestinal obstruction The occurrence of retreatment or secondary surgery.2.The use of biological patches for improved pelvic floor peritoneal repair can reduce patients' postoperative hospital stay compared with no pelvic floor peritoneal repair in laparoscopic assisted radical surgery for rectal cancer.3.The use of biological patches for improved pelvic floor peritoneal repair compared with no pelvic floor peritoneal repair in laparoscopic assisted radical rectal cancer surgery is simple,does not increase the patient's operation time,and does not increase the anastomotic leakage and infection.The occurrence of disease. |
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