| Research purposes: Anastomotic stenosis is one of the late complications of middle and low rectal cancer after anterior low rectal resection,with a low incidence and underreporting in most studies.Therefor e,this article anal yzes and discusses the related risk factors of anastomotic stenosis after low rectal resection for middle and low rectal cancer.Discuss the influencing factors of anastomotic stenosis,the significance of preserving the left colon arte ry on the incidence of anastomotic stenosis,and clarify the diagnostic criteria of anastomotic stenosis,which have important clinical significance for the prevention of anastomotic stenosis.Research method: The clinical data of 280 patients who were dia gnosed with middle and low rectal cancer and underwent anterior rectal resection from January 2017 to December 2019 in the General Surgery and Oncology Surgery Ward of Shaanxi Provincial People’s Hospital were selected.The retrospective anal ysis is in pro gress.Risk factors related to anastomoti c stenosis after surgery for low rectal cancer,including gender,age,maximum tumor diameter,distance from the tumor to the anal margin,degree of tumor differentiation,depth of tumor invasion(T stage),l ymph node metastasis(N stage),Postoperative pathological AJCC staging,postoperative anastomotic leakage,whether preventive ostom y was performed during the operation,whether the left colon artery was preserved during the operation,and the operation method.U se SPSS25.0software for data analysis.If the measurement data conforms to the normal distribution,use the mean ± standard deviation(`X±S)to describe,and use the independent sample t test for the comparison of the data between groups.If the measureme nt data does not conform to the normal distribution,Then appl y the rank sum test.Count data should be tested b yχ2 test,Fisher’s exact test should be used if necessary.Variables with statistical differences were further used b y binary logistic regressi on anal ysis.Statistical results P<0.05 were considered to be statisticall y different.Results:(1)Among all 280 patients,148 were males and 132 were females;the average age was 58.75±12.42 years;the average maximum tumor diameter was 4.78±1.99 cm;the average distance between the tumor and the anal margin was 6.66±1.87 cm.(2)Anastomotic stenosis occurred in 32 patients after surgery,the incidence rate was 11.4%(32/280),of which male accounted for 71.9%(23/32)and female accounted for 28.1%(9/32);age <50 46.9%(15/32)years of age,53.1%(17/32)of those aged 50 years or older;84.4%(27/32)of tumors ≤5cm from the anal margin,and proportions of >5cm 15.6%(5/32);postoperative anastomotic leakage accounted for 25.0%(8/32),no anastomotic leaka ge accounted for 75.0%(24/32);intraoperative preventive ostom y accounted for 75.0%(24/32),no preventive fistula accounted for 25.0%(8/32);intraoperative preservation of the left colon artery accounted for 9.4%(3/32),unreserved accounted for 90.6%(29 /32).(3)The results of univariate anal ysis showed gender(P=0.022),age(P=0.005),distance between tumor and anal margin(P<0.01),postoperative anastomotic leakage(P=0.013),preventive intraoperative Ostom y(P<0.01)and the absence of left colon art ery during operation(P=0.027)were related to the occurrence of anastomotic stenosis after middle and low rectal cancer.(4)The results of multivariate anal ysis showed that gender,age,and the distance between the tumor and the anal margin were independ ent risk factors for the occurrence of anastomotic stenosis after middle and low rectal cancer surgery(P<0.05).(5)Among the 32 patients with anastomotic stenosis,14 cases were diagnosed by the patient’s main complaint and clinical symptoms,22 cases were diagnosed b y the doctor palpating the stenosis ring through digital rectal examination,and the diagnosis could not be diagnosed by the 12 mm lens by colonoscopy.There are 32 cases.Conclusion:(1)Among patients with middle and low rectal cancer,men are more likely to develop anastomotic stenosis.(2)Among patients with middle and low rectal cancer,those younger than 50 years old are more likely to have anastomotic stenosis.(3)Among patients with middle and low rectal cancer,the tumor is less than or equal to 5cm from the anal margin,which is more likely to have anastomotic stenosis.(4)Anastomotic stenosis is diagnosed clinically mainly through12 mm colonoscopy. |
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