Application Of Terminal Ileum Stoma In Surgery Of Middle And Low Rectal Cancer

Objective:Comparisons of terminal ileum stoma and non-terminal ileum stoma,To explore the safety and clinical application value of terminal ileum stoma to prevent anastomotic fistula after operation.Methods:Retrospective analysis of the basic clinical data of 71 patients with middle and low rectal cancer from March 2018 to October 2019,including 31 patients underwent radical resection rectal carcinoma combined with terminal ileum stoma(ileostomy groups),40 patients only underwent radical resection rectal carcinoma(control group),comparing preoperative gender,age,BMI,the distance between the lower edge of tumor and the anal margin,preoperative albumin,preoperative hemoglobin,neoadjuvant therapy,intraoperative operative time,intraoperative blood loss,maximum diameter of tumor,postoperative anastomotic fistula,postoperative infection of incisional wound,postoperative electrolyte disturbance,postoperative intestinal obstruction,postoperative gut ventilation time,postoperative hospitalization time,postoperative drainage tube extubation time differences in clinical indicators.Contrast analysis of the safety and clinical application value of terminal ileum stoma to prevent anastomotic fistula after operation.Results:The age of the two groups was 65.15±8.34 in the ileostomy groups and 61.12±9.57 in the control groups(t=1.571,P=0.116),P>0.05;Gender:18 males and 13 females in the ileostomy groups,23 males and 17 females in the control groups(X2=0.002,P=0.962),P>0.05;BMI:21.54±2.73kg/m2 in the ileostomy groups and 22.73±3.29kg/m2 in the control groups(t=0.813,P=0.412),P>0.05;,preoperative albumin:38.86±3.73g/L in the ileostomy groups and 38.80±3.15g/L in the control groups(t=0.054,P=0.893),P>0.05;preoperative hemoglobin:105.53±6.37g/L in the ileostomy groups and 119.25±5.16g/L in the control groups(t=0.106,P=0.798),P>0.05,the distance between the lower edge of tumor and the anal margin:6.23±1.93cm in the ileostomy groups and 7.37±1.81cm in the control groups(t=0.257,P=0.713),P>0.05,neoadjuvant therapy:12 patients acceptant and 19 patients unaccepted in the ileostomy groups,11 patients acceptant and 29 patients unaccepted in the control groups(X2=1.002,P=0.317),P>0.05.There was no significant difference between the two groups before operation,and the data of the two groups were comparable.intraoperative operative time:213.10±51.31min in the ileostomy groups and 191.25±62.17min in the control groups(t=1.527,P=0.148),P>0.05,intraoperative blood loss:56.60±34.73ml in the ileostomy groups and 51.47±30.15ml in the control groups(t=0.271,P=0.844),P>0.05,maximum diameter of tumor:3.92±2.03cm in the ileostomy groups and 3.16±2.81cm in the control groups(t=0.513,P=0.693),P>0.05,postoperative anastomotic fistula:4 cases,A degree 3 cases,B degree 1 cases,C degree 0 cases in the ileostomy groups,15 cases,A degree 10 cases,B degree 4 cases,C degree 1 cases in the control groups(X2=4.209,P=0.040),P<0.05。The difference was statistically significant,indicating that the incidence of anastomotic fistula in the ileostomy groups was lower than that in the control groups;postoperative infection of incisional wound:3 cases in the ileostomy groups and 6 cases in the control groups(X2=0.075,P=0.757),P>0.05,postoperative electrolyte disturbance:5 cases in the ileostomy groups and 6 cases in the control groups(X2=0,P=1.000),P>0.05,postoperative intestinal obstruction:4 cases in the ileostomy groups and 8 cases in the control groups(X2=0.223,P=0.637),P>0.05,postoperative gut ventilation time:1.85±0.84 天 in the ileostomy groups and 2.58 ± 1.18 天 in the control groups(t=2.491,P=0.017),P<0.05。indicating that the gut was ventilated earlier in the control group,postoperative hospitalization time:8.15±1.92 day in the ileostomy groups and 10.42±2.37 day in the control groups(t=2.172,P=0.041),P<0.05。indicating that the length of hospitalization in the ileostomy groups was shorter than that in the control groups,postoperative drainage tube extubation time:7.38±1.42 day in the ileostomy groups and 10.71±3.19 day in the control groups(t=3.159,P=0.007),P<0.05,indicating that the drainage tube was pulled out earlier in the control groups,tumor TNM stages:stages Ⅰ 5 cases,stages Ⅱ 8 cases,stages Ⅲ 18 cases in the ileostomy groups,stages Ⅰ 16 cases,stages Ⅱ 12 cases,stages Ⅲ 12 cases in the control groups(X2=6.729,P=0.035),P<0.05。indicating that tumor staged later are more need to terminal ileum stoma,hospitalization expenses:46552.69±3819.13 yuan in the ileostomy groups and 49560.97±3837.26 yuan in the control groups(t=0.027,P=0.905),P>0.05Conclusion:Terminal ileum stoma can reduce the incidence of anastomotic fistula,reduce the hospitalization time,reduce gut ventilation time and extubation time after operation,which has important clinical application value.