| Objective:The clinical value and significance of prophylactic ileostomy in the anus preserving operation of low rectal cancerMatterials and Methods:Retrospective analysis of the clinical data of low rectal cancer patients admitted from January 2014 to December 2017 in our hospital.The patients were divided into experimental group and control group according to whether preventive measures were used during the operation.The experimental group underwent low rectal anterior resection and preventive ileostomy,while the control group only received low rectal anterior resection.To analyze the relationship between sex,age and BMI,ASA grade,operative method(laparoscopy or laparotomy,pathological type of tumor,clinical stage)and anastomotic fistula.To analyze the causes of anastomotic fistula,and to evaluate the role of preventive ileostomy in reducing the incidence of anastomotic fistula after rectal cancer surgery.Results:1.There was only one anastomotic fistula in the experimental group.After the operation,the patients were discharged from hospital after fasting and parenteral nutrition support.No secondary operation was performed.In the control group,13 cases had anastomotic fistula,9 of them were discharged from hospital after fasting,washing and drainage treatment,and 4 patients were not treated with conservative treatment for 3 days,and abdominal pain was aggravated.The emergency colon ostomy was performed.The incidence of anastomotic leakage in the two groups was compared: the incidence of anastomotic leakage in the experimental group was 1.96%(1/51),and the incidence of anastomotic leakage in the control group was 12.6%(13/103),the difference was statistically significant(P<0.05),and no death occurred in all the patients with anastomotic fistula during the perioperative period.2.There was no significant difference in sex,age,obesity ASA grade,surgical procedure,tumor stage and postoperative anastomotic fistula incidence(P > 0.05).3.Comparison of postoperative food intake and hospitalization time between the two groups: The average time of eating in the experimental group was 3.5 + 1.27 days,while that in the control group was 5.5 + 0.95 days,t=10.96,p<0.01,The average hospitalization time in the experimental group was 10.5 + 3.5 days,while the control group averaged 16.5 + 2.5 days,t=8.15,p<0.01.The results of statistical analysis showed that prophylactic ileostomy could make the patients eat earlier and shorten the hospitalization time after operation.4.In the observation group,there were 1 cases of intestinal obstruction,4 cases of incision infection,6 cases of dehydration,electrolyte disturbance,1 cases of stoma retraction,2 cases of stoma prolapse,2 cases of paranostomy hernia,no stoma necrosis,4 cases of intestinal obstruction,5 cases of incision infection and 3 electrolyte disorders in the control group.There was no significant difference in the incidence of intestinal obstruction,incision infection,dehydration and electrolyte disturbance between the two groups(P > 0.05).The incidence of stoma prolapse was lower than that reported in relevant literature,and no serious consequences were found through active and effective treatment.Conclusions:1.This study found that the age,sex,BMI,ASA classification,surgical methods,tumor diameter,tumor clinical staging and anastomotic fistula were not related to the occurrence of anastomotic fistula,and the analysis of related risk factors needed further study.2.Prophylactic ileostomy can significantly reduce the incidence of anastomotic fistula and the rate of reoperation after operation for low rectal cancer.For patients with anastomotic fistula,temporary ileostomy can also reduce its harm.3.Temporary ileostomy can also make patients take food earlier after operation,shorten the hospitalization time of patients,and accelerate the healthy speed of patients.It is a safe and effective method to prevent anastomotic fistula after operation of low rectal cancer.It is worth popularizing and applying in clinic. |
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