Analysis Of The Safety And Efficacy Of Preventive Ileostomy In Elderly Patients Undergoing Laparoscopic Radical Resection Of Low Rectal Cancer

Objective:To investigate the clinical safety and efficacy of prophylactic ileostomy in laparoscopic radical resection of low rectal cancer in the elderly.Methods:The clinical data of sphincter-preserving surgery for elderly patients with low rectal cancer in the Department of Gastrointestinal surgery of the second affiliated Hospital of Nanchang University from August 2019 to August 2021 were analyzed retrospectively.after certain inclusion and exclusion criteria,124 cases met the criteria,including 78 males and 46 females.According to whether the distal ileostomy was performed during the operation,the patients were divided into observation group(n = 42)and control group(n = 82).According to the general condition and basic data of the patients,such as age,sex,BMI,tumor location,tumor pathological stage,etc.;the time spent in the operation,the amount of bleeding;the time of postoperative parenteral nutrition,hospital stay,the first exhaust time,the total cost of hospitalization;postoperative complications such as wound infection rate,anastomotic fistula,bleeding,secondary operation,ascites,pulmonary infection,diarrhea and constipation,intestinal obstruction,etc.Short-term postoperative psychological anxiety and depression,quality of life and other factors were statistically analyzed to show the difference in clinical efficacy,safety and effectiveness between the observation group and the control group.Results:1.There was no significant difference in age,sex,BMI,tumor location and tumor pathological stage between the two groups.2.The time of operation cost in the observation group was longer than that in the control group,and the difference was statistically significant(P < 0.05).There was no significant difference in the amount of operative blood loss between the two groups(P > 0.05).3.Compared with the control group,the postoperative parenteral nutrition time,hospital stay and the first exhaust time in the observation group were significantly shorter,and the total hospitalization cost was higher than that in the control group(P< 0.05).4.There was no significant difference in the incidence of anastomotic leakage between the two groups(P > 0.05),but the total incidence of complications in the observation group was significantly lower than that in the control group(P < 0.05).5.The comparison of the scores of generalized anxiety disorder scale(GAP-7)and depression screening scale(PHQ-9)between the observation group and the control group showed that the patients in the observation group might have mild anxiety and depression in the first month and the third month after operation,and the difference was statistically significant.The above states disappeared at the 6th month after operation.The comparative results of quality of life rating scale(EORTCQLQ-C30)showed that the colostomy group performed better in general health status,diarrhea and constipation,but worse in role function,and the difference was statistically significant(P < 0.05).There was no significant difference in other areas among the follow-up time groups.Conclusion:1.Preventive ileostomy has certain advantages in shortening postoperative parenteral nutrition time,hospital stay and postoperative nutritional status,and it is a safe and effective treatment for low rectal cancer in the elderly.2.Prophylactic ileostomy may not prevent the occurrence of anastomotic leakage after operation of low rectal cancer,but it can reduce the total postoperative complications,reduce the severity of anastomotic leakage and reduce the rate of reoperation.3.Prophylactic ileostomy may cause psychological depression and mild anxiety.Anxiety and depression disappear after colostomy.Patients with preventive ileostomy have better quality of life in the short term after operation.