Clinical Analysis Of Benign Anastomotic Stenosis After Low Anterior Resection Of Laparoscopic Rectal Cancer

Objective:Low rectal anastomosis due to the particularity of its anatomical location,and because of the high incidence of anastomotic leakage,it is possible to perform proximal bowel tube bypass,and the complications of anastomotic stenosis have its own characteristics.This study performed laparoscopic anterior resection for patients with rectal cancer Patients with posterior benign anastomotic stenosis(Benign Anastomotic Stenosis,BAS)were grouped according to whether they were undergoing proximal bowel bypass to explore the characteristics of BAS in terms of incidence,clinical manifestations,and treatment.Methods:The clinical data of patients who underwent laparoscopic rectal cancer low anterior resection between June 2016 and June 2019 of Zunyi Medical University Affiliated Hospital were collected for retrospective analysis.Flow group and non-diversion group:(1)Count the incidence of BAS in all patients;(2)Compare the difference in the incidence of BAS between the two groups;(3)Analyze the diagnosis characteristics of BAS in two groups of patients;(4)Analyze the clinical types of anastomotic stenosis in two groups of patients;(5)Collect BAS treatment methods and treatment effects of the two groups of patients,and compare the differences in the last treatment methods of the two groups of patients;(6)Follow-up patients with BAS recurrence.Results: A total of 422 patients after laparoscopic rectal cancer low anterior resection were included according to the inclusion and exclusion criteria,of which367 had no transfer stoma and 55 had transfer stoma.(1)A total of 10 out of 422 patients developed BAS,and the incidence of BAS was2.4%;(2)The incidence of BAS was 9.1%(5/55)and 1.4%(5/367)in the transfer stoma group and BAS in the non-transfer stoma group,the difference was statistically significant(P <0.01);(3)Diagnosis characteristics: 5 cases of BAS patients in the non-transfer stoma group and in the transfer stoma group,the patients in the non-transfer stoma group presented for incomplete intestinal obstruction symptoms,and the anastomosis and colonoscopy confirmed the anastomotic stricture;Patients in the transfer stoma group were asymptomatic and did not find contrast agent spillage(4/4)by barium enema before the ostomy was accepted,but the examination failed to clearly define the anastomotic stenosis,followed by anal diagnosis and enteroscopy Examination clearly revealed anastomotic stenosis.(4)BAS membranous stenosis accounted for 40%(2/5)in the transfer stoma group and 60%(3/5)in the tubular stenosis;100%(5/5)in the non-transfer stoma group BAS tubular stenosis,and no cases of diffuse stenosis were found in both groups.(5)The last effective treatment method for 10 BAS patients is:(1)5 patients in the transfer stoma group,finally through finger dilation,endoscopic anastomotic ring incision and surgical reconstruction of the digestive tract to relieve stenosis,the effective rate is 3 Cases(60%),1 case(20%),and 1 case(20%);(2)5 patients in the non-transfer stoma group were all relieved by endoscopic anastomotic ring resection,and the effective rate of this method was 100%(5/5).(6)Follow-up observations were made on 10 patients.The follow-up period was from6 months to 24 months,and the median follow-up period was 10 months.There was no recurrence of anastomotic stricture.Conclusion:(1)BAS is more likely to occur in patients with low-level anterior resection of laparoscopic rectal cancer after proximal bowel diversion;(2)The clinical manifestations of patients without proximal bowel tube bypass and BAS patients with proximal bowel tube bypass are significantly different,so the diagnosis process is different.For patients with proximal bowel tube bypass,barium enema is also included in the stoma Check to assess whether there is anastomotic leakage,and anal examination and enteroscopy are also required to determine whether there is anastomotic stenosis.(3)There are differences in the clinical types of BAS between the transfer stoma group and the non-transfer stoma,which may be the reason for the difference in the treatment of BAS remission in the two groups.