Postoperative Anastomotic Fistula With Membrane Stent In Rectal Cancer Clinical Application In Treatment

Objective:A retrospective study was performed on the curative effect of stent implantation in the early treatment of postoperative anastomotic fistula,and provided theoretical support for the application of the technique in the early treatment of anastomotic fistula.Methods:From June 2012 to January 2017,23 patients with anastomotic fistula after rectal cancer rectal cancer rectum preservation surgery were selected from the fifth affiliated hospital of zhengzhou university,and their case data were retrospectively analyzed.All 23 patients were given conservative treatment regimens such as routine anti-infection,fistula treatment and nutritional support.In 8 cases,early stent implantation was performed on the basis of conservative treatment.The remaining 15 patients were treated conservatively only and were included in the control group.Observation indexes: the sex,age,operation mode,Dukes stage and nutritional status of the two groups of patients were recorded and analyzed statistically.Clinical treatment effect of anastomotic fistula in two groups;Daily drainage and retention time of anterior sacral drainage tube;Healing time of fistula;WBC,PCT and prealbumin values at day 1,4,7 and 10 before and after treatment;Follow-up data on complications at 5 months after treatment.Results:1.There was no statistically significant difference between the control group and the experimental group in gender,age,surgical method,Dukes stage,anastomotic fistula,and nutritional status(P>0.05).2.The clinical treatment effect comparison: the experimental group patients have one stand out,recovered after conservative treatment,residual fistula by placing stents in all 7 cases sealing mouth is successful,remove the scaffold anastomotic all healed well;Observation group 15 cases were healed after conservative treatment.There was no statistically significant difference between the two groups(P<0.05).3.Comparison of the daily flow rate and retention time of the anterior sacral drainage tube during the treatment period(during the placement of the drainage tube):comparison of daily flow rate: the experimental group(40.33 + 4.75ml)and the control group(100.16 + 4.01ml);The experimental group was significantly less than the control group,and the difference was statistically significant(P < 0.05).Comparison of the retention time of drainage tube: observation group(13 ~ 37 d,average 23.5d),control group(19 ~ 75 d,average 42.4d);The experimental group was significantly shorter than the control group,and the difference was statistically significant(P<0.05).4.Comparison of fistula healing time: experimental group(12 ~ 32 d,average20.5d),control group(14 ~ 71 d,average 37.8d);The healing time of fistula in the observation group was significantly shorter than that in the control group,and the difference was statistically significant(P<0.05).5.Before and after treatment 1,4,7,10 days before the WBC value,PCT,albumin value contrast: the two groups before treatment and after treatment 1 day before the WBC,PCT,albumin results no significant difference(P > 0.05),4,7,10 days after treatment the WBC,PCT observation groups was statistically significant reduction,4,7,10 days after treatment group prealbumin rise statistically significant(P<0.05).6.The postoperative complications incidence of contrast: the observed group there were 1 cases appeared complications,1 cases of stent displacement,the incidence of complications was 12.5%,while the control group after treatment,patients with a total of 6 cases with complications,including 3 cases of anastomotic stricture,1 case of pulmonary infection and 2 cases of pelvic abscess,the incidence of complications was 40%,the incidence of complications of observation group was obviously lower than the control group,the difference was statistically significant(P< 0.05).Conclusions:1.Covered stent implantation can complete isolation from the pelvic and lumen,effectively prevent the lumen contents to leak into the pelvic cavity,reduce the pollution of the pelvic and abdominal cavity and blood infection risk,reduce the risk of complications in anastomotic fistula treatment.The implantation of membrane support is beneficial to the healing of fistula and shorten the healing time of fistula.2.Implantation of membrane stent has certain supporting effect on the local spatial structure of the surgical anastomosis,which can prevent the occurrence of anastomosis stenosis to a certain extent.3.Early after stent placement with membrane,to some extent,is beneficial to the recovery of patients with nutritional health,is conducive to maintaining environment in patients with relatively steady,avoid the excessive activation of inflammatory reaction,conform to the(ERAS)accelerated rehabilitation surgical management.4.Clinical placement of covered stents in the treatment of anastomotic fistula should be strictly grasp the indications: the technology is suitable for fistula location away from the dentate line for more than 3 cm,when low fistula location,use the stent prone to slip,placement of stents must choose appropriate diameter size,lest stents caliber inconsistent with rectal lumen diameter size lead to shift,after stent implantation should give short-term liquid diet,avoid a strong shock bowel peristalsis stent displacement caused.