The Application Of Preventive Terminal Ileostomy In Laparoscopic Radical Resection Of The Low Rectal Cancer With Preservation Of Anus

Objective:To investigate the feasibility, safety and clinical efficacy of Preventive terminal ileostomy in la Parosco Pic radical resection of the low rectal cancer with Preservation of anus. Methods:From February 2013 to APril 2014 From February 2013 to APril 2013, 96 Patients who would be underwent la Parosco Pic radical low rectal cancer surgery in General Surgery De Partment of the Peo Ple’s Hos Pital, Henan Province were randomly divided into ex Perimental grou P(Preventive ileostomy) and control grou Ps(not Preventive ileostomy), 48 cases of each grou P. The hos Pital ethics committee agreed this ex Periments, and all Patients signed informed consent before enrolled. Patients in ex Perimental grou P were treated with Preventive dual-chamber terminal ileostomy besides radical resection. While Patients in control grou P were treated with the conventional anastomosis, each drainage tube was Placed with anus, Pelvic cavity and Peritoneal cavity without terminal ileostomy. Totally, 86 Patients(44 cases of the ex Perimental grou P and 42 cases of the control grou P) com Pleted the study.96 Patients who would be underwent la Parosco Pic radical low rectal cancer surgery in General Surgery De Partment of the Peo Ple’s Hos Pital, Henan Province were randomly divided into ex Perimental grou P(Preventive ileostomy) and control grou Ps(not Preventive ileostomy), 48 cases of each grou P. The hos Pital ethics committee agreed this ex Periments, and all Patients signed informed consent before enrolled. Patients in ex Perimental grou P were treated with Preventive dual-chamber terminal ileostomy besides radical resection. While Patients in control grou P were treated with the conventional anastomosis, each drainage tube was Placed with anus, Pelvic cavity and Peritoneal cavity without terminal ileostomy. Totally, 86 Patients(44 cases of the ex Perimental grou P and 42 cases of the control grou P) com Pleted the study. Observation indicators are as follows:1、Recorded general information of the two grou Ps of Patients and Performed statistic analysis.2、Recorded the o Peration time, blood loss in the surgery of two grou Ps and com Pared using t-test for inde Pendent sam Ples.3、Recorded the first-anal-exhaust-time, the first-ambulation-time after o Peration, the total days of rehydration, and the average-hos Pital-days then statistically com Pared using t-test for inde Pendent sam Ples.4、Recorded and analyzed the WBC, CRP and Pre-albumin test results in Preo Perative and Posto Perative day 2, day 5.5 、 Recorded incidence of anastomotic fistula, intra-abdominal bleeding, anastomotic obstruction, urinary retention and lung infection etc. of Posto Perative and com Pared between the two grou Ps with Chi-square test.6、Recorded the anal function recovery status of Patients in two grou Ps at two weeks, three months, six months after surgery, evaluated by Xu Zhong’s criteria and com Pared with t test. Results1 、 The ex Perimental grou P and the control grou P showed no significant difference in general terms.(P> 0.05).2、Com Pared with the control grou P, the ex Perimental grou P showed slightly longer surgical time(unit:minute)(162.21±25.67)/(179.50±30.86)(P=0.059), while the blood loss(unit:ml)(76.71±24.12)/(75.95±25.08)( P=0.8864) showed no statistical difference.3、The ex Perimental grou P was Prescribed oral liquid diet after 2 days of o Peration. The control grou P was given clear liquid diet after exhaust. The total rehydration days were significantly shorter than the control grou P(4.1±0.9)/(6.4±1.5) d(P=0.000); During the Posto Perative recovery, Patients in the ex Perimental grou P Presented earlier first-anal-exhaust-time(2.1±1.1)/(4.8±1.3) days(P=0.000) and first-ambulation-time(1.8 ± 0.9)/(3.9 ± 1.8)(P=0.000)days, also the shorter average-hos Pital-days(8.7±1.2)/(12.9±2.1) days(P=0.000) than the control grou P.4、No significant differences were found between Preo Perative results and the Posto Perative day 2 with WBC, CRP and Prealbumin. While at the day 5, WBC, CRP indicators significantly decreased and Prealbumin increased in the ex Perimental grou P.5 、 There were significant differences in the Posto Perative incidences of anastomotic fistula, intra-abdominal bleeding, anastomotic obstruction, lung infection and urinary retention etc.between the two grou Ps.6、The quality of life was not ideal at day-14 of Post-surgery, with no significant difference in two grou Ps; The anal function of Patients were restored to a large extent at 3 months after o Peration. Patients in ex Perimental grou P were gradually ada Pted to the stoma, the overall quality of life was significantly better than that in the control grou P; At six months after surgery, the small intestine in the ex Perimental grou P had been Put back for three months. The recovery of bowel function was better in the control grou P and Patients in the ex Perimental grou P did not a PPear obvious com Plications. While 4 Patients in the control grou P had anastomotic leakage in 7-12 days after surgery. All 4 cases were im Proved by Placing double lumen drainage tube and washing. ConclusionsPatients in la Parosco Pic radical resection of the low rectal cancer who Performed Preventive terminal ileostomy may accelerate recovery s Peed, relieve inflammatory res Ponse after surgery. Com Pared with the control grou P, Protein synthesis was faster, nutritional status was better, anal function recovery was more ideal, the risk of o Peration was reduced, com Plications such as lung infections, abdominal cavity bleeding and other com Plications were significantly decreased in the ex Perimental grou P. The total days of rehydration, and the average-hos Pital-days were also reduced. So herein we recommended Preventive terminal ileostomy for high-risk grou Ps. Whether it is demanded as a conventional method for all Patients in la Parosco Pic radical resection of the low rectal cancer, still need more clinical trials to investigate further.