Clinical Observation Of Early Closure Of Rectal Cancer After Laparoscopic Low Anterior Resection Combined With Preventive Fistulation

Objective:To evaluate the safety and feasibility of early closure of the stoma after laparoscopic low anterior resection of rectal cancer combined with preventive terminal ileostomy in patients with rectal cancer,as well as the satisfaction and quality of life of patients after surgery.Methods:A retrospective analysis was used to collect cases of rectal cancer who underwent laparoscopic low anterior resection of rectal cancer + preventive terminal ileostomy for rectal cancer from January 2018 to June 2020 in the Department of Gastrointestinal Surgery,Affiliated Hospital of Zunyi Medical University.Month is the time point of closed fistula,divided into early group and routine group.(1)Compare the two groups of patients with closed fistula surgery,the results of major postoperative complications,and other surgery-related conditions: operating time,intraoperative blood loss,postoperative wound infection,anastomotic leakage,inflammatory bowel obstruction,postoperative bleeding,Postoperative hospital stay,re-admission within 30 days after surgery,death within 30 days after surgery,hospitalization expenses.(2)Follow-up by telephone to investigate the postoperative satisfaction of the two groups of patients and the quality of life in the early group one month after surgery.Results:According to the selection criteria of inclusion and exclusion,a total of 83 patients were selected,including 35 cases in the early group(n=35)and 48 cases in the routine group(n=48).(1)The operation time for fistula closure of the two groups of patients were: 95(75;113)minutes in the early group and 84(65;115.75)minutes in the conventional group.There was no statistically significant difference in the operation time of fistula closure between the two groups(P= 0.383);there was no significant difference in intraoperative blood loss between the two groups(P=0.519).(2)Comparison of complications between the two groups of patients: 6 patients(17.1%)in the early group had intraoperative infection,and only 1 patient(2.1%)in the conventional group had intraoperative infection(P=0.042);the two groups of patients had postoperative infection There was no statistically significant difference in the complications of ileal anastomotic leakage,postoperative inflammatory bowel obstruction,and bleeding in the operation area.(3)There was no significant difference between the two groups of patients during the hospitalization period(P=0.121)and postoperative hospitalization time(P=0.432).There were no patients who died within 30 days after surgery;patients in the early group were 30 days after surgery.There were no re-admission cases due to complications related to this operation within the day,and there was 1 case in the routine group.(4)The overall satisfaction with the operation of the two groups of patients were:4.49±0.56 points in the early group,4.48±0.58 points in the routine group(P=0.959);the quality of life in the early group was the same as that of patients who had not closed fistula during the same period.Comparing the various scores of quality of life,there is no significant difference in "Physical Health(P=0.171)","Mental Health(P<0.001)","Ambient Environment(P<0.001)" and "Social Relations(P<0.001)",etc.On the aspect,the score is higher after closing the fistula early.Conclusion:(1)Patients who underwent rectal cancer low anterior resection +preventive terminal ileostomy can choose to close the fistula early when there are no significant postoperative complications,and there is no difference between the operation time and the bleeding during the operation and the routine time for the fistula closure.It is statistically significant and does not increase the difficulty of the operation;(2)Preventive ileostomy has increased complications after closing the fistula in the early stage,mainly due to the increase in the infection rate of the incision,but the infection is limited and controllable,and it does not bring serious consequences to the patient;(3)Preventive ileostomy can improve the patient’s quality of life earlier after closing the fistula early.