| Objective: To compare the quality of life(QOL)and nutritional status of patients with low rectal cancer treated by transabdominal perineum combined resection and internal and external sphincterectomy,and to campare the local recurrence distant metastasis rate within two years after operation.The aim is to provide a more reliable theoretical basis for the choice of surgical methods in patients with low rectal cancer.Methods: Patients with advanced low rectal cancer who underwent surgical treatment between June 2014 and December 2015 in affiliated Hospital of North Sichuan Medical College were selected.There were 40 cases of permanent fistula(fistula group)and 40 cases of anal preservation by internal and external sphincterotomy(anal preservation group).The European Organization For Research and Treatment of cancer therapy was used to develop the General quality of life Quality of life Questionnaires of Cancer-30 QLQ-C30,quality of life Questionnaires of Colorectal Cancer-38(QLQ-CR38)and self-made scale were used to compare the quality of life,nutritional status(body weight,hemoglobin level)between the two groups.Serum protein level)and local recurrence and distant metastasis rates within 2 years after operation.Results: the total 80 cases of low rectal cancer patients,two groups of 40 cases,there was no significant difference between the two groups of clinical data(P > 0.05).The quality of life assessment:postoperative June QLQ-C30:colostomy group fatigue,diarrhea and difficult economic dimensions were better than the anus group(P < 0.05)operation.After JuneQLQ-CR38:anus fistula group is better than that of body image group(P <0.05).QLQ-C30 one year after operation:anus fistula group total quality of life is better than that of group QLQ-CR38(P < 0.05).One year after surgery:anus group,body image,sexual problems,views on the future,urination,discharge.The problem and the decrease of body weight dimensions were better than the colostomy group(P < 0.05).The nutritional status:half a year after the operation of two groups had no statistically significant difference(P > 0.05);one year after the operation of two groups had no statistically significant difference(P > 0.05).Other items and dimensions of the difference between each group no statistical significance(P > 0.05).Results of local recurrence and distant metastasis: there was no significant difference between anal preservation group and fistula group(P >0.05).Conclusion: The internal and external sphincter is the embryonic plane where the visceral structure is fused with the surrounding body skeletal muscle structure,and is the barrier for the terminal rectal cancer to infiltrate into the periphery.Rectal neoplasms mainly invade the visceral structure of the endoderm,that is,the proximal rectum and the distal anal canal,and the tumor diffuses within the visceral structure.These visceral structures and the pelvic floor skeletal muscle derived from the mesoderm are derived from different histological sources.There is a histopathologic difference between the two methods in the treatment of low rectal cancer.It is based on this difference that these visceral structures are removed without damage to the pelvic floor skeletal muscle.The structure of the anal sphincter is preserved as much as possible,and the intestinal sphincter is kept intact.The continuity of the canal was reconstructed and the postoperative anorectal function and thequality of life of the patients were better than those after APR.At the same time,the indications of anal preservation surgery were strictly grasped.The local recurrence rate of the tumor can also be well controlled.Therefore,for patients with low rectal adenocarcinoma(I / II / III),patients with locally less than T3,the quality of life of patients after ISR anal preservation surgery is superior to that of traditional transabdominal perineum combined excision.And does not increase the chance of recurrence,this operation is worthy of recommendation. |
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