Application Of Fecal Diverting Technique On Rectal Anastomosis In Anus-preserving Operation For Middle And Low Rectal Cancer

Objective: To investigate the effect of rectal anastomotic stool shunt on the prevention of anastomotic leakage after low and advanced rectal cancer resection.Methods: We retrospectively analyzed 98 low and middle rectal cancer patients admitted to the Department of Gastrointestinal Surgery,Nanjing Military Region General Hospital,Fuzhou from September 2015 to December 2017.Of the 49 patients admitted to our hospital from September 2015 to September 2016,Traditional end-stage ileostomy(control group)performed re-incision and re-incision again 3-6 months later.The other group received 49 cases of rectal anastomosis during October 2016-December 2017 Oral stool shunt(experimental group),that is,when the anastomosis of the colorectal anastomosis into the large diameter of the drainage tube in the reconstruction of the rectum,with one end of the balloon so that the lower reaches of the balloon to reach about 5cm above the anastomosis,Filling the balloon to fill with water and intestinal wall basically fit.The lower end of the balloon corresponds to the large mesenteric vascular pliers with a small hole around the small intestine bypass around a No.6 suction tube diameter of about 2mm,,pull the suction tube after lagging into a diameter of about 6mm drainage bag tube,in the left lower abdominal wall to take a small stretch pulled to the body after the knot fixed,so that the feces diverted out of the bag by drainage tube.7 days after angiography examination,the anus injection of diatrizoate meglumine,observe whether there is leakage of diatrizoate meglumine.If no postoperative anastomotic fistula,the first removal of the left lower quadrant drainage tube,then pull the large diameter anal canal air bag,remove the large-diameter drainage tube.Comparing the incidence of anastomotic leakage and the incidence of incision infection,the amount of intraoperative blood loss,the total cost of treatment,the length of postoperative hospital stay,and the patient's score on the surgery after surgery of two groups.Results: The incidence of anastomotic fistula(2%(1/49)vs 2%(1/49)],blood loss in the experimental group and control group(56±23 vs 63±20)ml and VAS score(6.8±1.0)VS(7.2±1.1)],the difference was not statistically significant(P> 0.05).However,the stool infection in the recto-anastomosis was significantly different in the length of stay [(12.4±2.4)VS(18.2±2.2)] and the cost of treatment [(6.26±0.6)VS(9.52±0.4)/ 49)VS 5%(5/49)] were less than those of the traditional terminal ileum ostomy group,the difference was statistically significant(P <0.05).Conclusion: The fecal diverting technique on rectostomach and the traditional end ileostomy can significantly reduce the incidence of anastomotic leakage.What's more,the fecal diverting operation on rectal anastomosis can shorten the hospitalization time,reduce the cost of treatment,and reduce the incidence of incision infection.At the same time,it can avoid secondary surgery of the stoma and improve the patient's quality of life.In a word,The fecal diverting technique on rectal anastomosis is a safe and effective treatment.