The Value Of Nonfunctioning Stoma In Low-grade Total Mesorectal Exision Of Rectal Carcinoma

Objective:To discuss the value of nonfunctioning stoma in low-grade total mesorectal excision of rectal carcinoma.Methods:Collect clinical data of patients with rectal carcinoma from April 2009 to October 2010.The patients that the distance from the inferior margin of the tumor to the anal verge is less than 5cm had been chosen, except the patients with acute obstruction and the patients underwent Mile's surgery. All the chosen patients underwent the electronic colonoscope exam and biopsy. The pathology test had confirmed the exit of carcinoma. The patients were randomly classified in nonfunctioning stoma group and without nonfunctioning stoma group. The patients in the nonfunctioning stoma group underwent ileum stoma surgery after anastomose. Compare these two groups from anastomotic leakage, length of stay in hospital and other complications.Results:1,Anastomotic leakage:4 cases of 35 patients developed anastomotic leakage in the nonfunctioning stoma group, the incidence rate was 11.43%. The number of without nonfunctioning stoma group was 12.07% with 7 cases in 58 patients. There was no distinct difference in statistics (p=0.757) between two groups. But when the patients with nonfunctioning stoma developed asastomotic leakage, their symptom was slight, and resumed rapidly after expectant treatment, such as enteral nutrition, irrigation of peritoneal cavity through the drainage tube and so on. Otherwise, there were 55 male patients in this group, and 9 of them developed anastomotic leakage. The incidence rate was 16.4%. The number of female patients was 5.3% with 2 cases in 38 female patients. The anastomotic leakage rate of male patients was apparently higher than the one of female patients.2,The length of stay in hospital:The length of stay in hospital of the patients without anastomatic leakage was separately 21.4 days and 20.2 days in nonfunctioning stoma group and without nonfunctioning stoma group. There was no distinct difference either (t=0.772, p=0.443). Because of some patients with anastomotic leakage gave up staying in the hospital, the comparing of the length of stay in hospital of the patients with anastomotic leakage between two groups had no meaning. 3,The other complication:There was one case of uroschesis, one case of bowl obstruction, and one case of pulmonary embolism in nonfunctioning stoma group. There was one case of bowl obstruction and one case of anastomotic stricture after return the stoma. The complications of the other group were 5 cases of uroschesis, no other serious complications were found. The surgery of ileum stoma may increase the risk of complications.Conclusions:1,The nonfunctioning stoma has positive effect in the patients with anastomotic leakage.2,The nonfunctioning stoma surgery has no use in reducing the rate of anastomotic leakage after total mesorectal excision, and this kind of surgery increases the burdens of patients in physiology, psychology and economy.3,The nonfunctioning stoma surgery should be used according to the risk of anastomotic leakage, but not routinely.