Application Of Prophylactic Ileostomy In Elderly Patients With Laparoscopic Radical Resection Of Low Rectal Cancer

Objective:To explore the feasibility and clinical value of prophylactic ileostomy in elderly patients with laparoscopic radical resection of low rectal cancer.Methods:The clinical data of 104 patients with low rectal cancer who underwent laparoscopy sphincter-preserving surgery from July 2017 to June 2019 in China-Japan Union Hospital of Jilin University were retrospectively analyzed,including 61 males and 43 females,aged from 60 to 83 years old,with an average age of(67.51 ±6.77)years.According to the use of preventive ileostomy,104 patients were divided into observation group(ileostomy group)and control group(non-ileostomy group).There were 34 patients in the observation group(32.7%)and 70 patients in the control group(67.3%).The parameters of two groups were compared and statistically analyzed:the basic data and general conditions of the two groups,such as age,sex,BMI,tumor location,tumor pathological classification and tumor stage(TNM),etc;the related indexes during operation,such as the time of operation,the amount of blood loss during surgery;the related indexes of postoperative inflammatory stress reaction,such as white blood cell count(WBC),procalcitonin(PCT)and albumin(ALB)before operation and on the 1st,3rd and 7th day after operation;the related indexes of postoperative rehabilitation,such as the time of first anal exhaust,the days of postoperative nutrientsinfusion,postoperative hospital stay,etc;postoperative complications,such as anastomotic leakage,pelvic hemorrhage,secondary operation,incision infection,ascites,pulmonary infection,postoperative urinary retention,intestinal dysfunction,intestinal obstruction and other factors.Result:1.There was no significant difference between the two groups in the age,sex,BMI,tumor location,tumor pathological type and tumor stage(P>0.05).2.There was no significant difference in intraoperative conditions such as operation time and intraoperative blood loss between the two groups(P>0.05).3.Compared with the control group,the first exhaust,total fluid replacement time and postoperative hospital stay in the observation group were significantly shorter than those in the control group(P <0.05).4.There were significant differences between WBC,PCT and ALB observation group and control group at different time points before and after operation(P<0.05).Multivariate analysis of variance at the same time between WBC,PCT and ALB groups showed that there were significant differences in WBC,PCT and ALB on the seventh day after operation(P < 0.05),but there was no significant difference before operation,the first day and the third day after operation(P>0.05).5.There was no significant difference in the incidence of independent complications including anastomotic leakage between the two groups(P > 0.05).However,the total incidence of complications was 6 cases(17.6%)in the observation group(n = 34)and 26 cases(35.7%)in the control group(n = 70).The difference has statistically significance(P<0.05).Conclusion:1.Preventive ileostomy could not prevent the occurrence of anastomotic leakage after operation of low rectal cancer,but it can reduce the severity of anastomotic leakage and the rate of reoperation.2.Prophylactic ileostomy has certain advantages in accelerating postoperative food intake,reducing surgical stress and shortening hospitalization time,which accords with the concept of ERAS.And the preventive ileostomy is a safe,effective and simple treatment for low rectal cancer in the elderly.