A Comparative Study Of Ileal Loop-type Ileostomy And Modified Terminal Ileum Cannula Ileostomy In Anus Preservation Operation On Low Rectal Cancer

Objective: Retrospective analysis of clinical datas of patients who underwent low rectal cancer(LRC)resection with conventional ileal loop-type ileostomy or modified terminal ileum cannula ileostomy(mTICI),this study shall investigate the safety and efficacy of mTICI and provide references for choosing the defunction stoma method in anus preservation operation on low position rectal Cancer.Methods: According to the standard of inclusion and exclusion,a total of 60 patients with low rectal cancer(LRC)resection in our hospital from September 2016 to August 2018 were selected as the subjects of the study.Among them,25 cases were treated with modified terminal ileum cannula ileostomy,and the other group was ileal loop-type ileostomy(n =35),grouped according to defunction stoma method.The datas of the two groups were compared and analyzed,including general and pathological datas,intraoperative and postoperative recovery datas,postoperative complications and follow-up results.SPSS19.0 software was used for statistical analysis,the measurement data were expressed as the ±S,the two groups were compared with T test,and the count data were tested by X2.P<0.05 was found to be statistically significant.Results: There were 25 patients in the group of mTICI,and the loop-type ileostomy group had 35 cases.There was no statistical difference between the two groups in general clinical datas.There was no significant difference between the two groups in operation time,operation blood loss,intestinal function recovery time,eating time.There were significant differences in the postoperative hospital stay,Hospitalization expenses.The length of the postoperative stay was 8.68±0.95 days in the mTICI group and 14.46±1.20 days in the loop ileostomy group,including time for the initial and reversal operations.In the mTICI group,the total cost of patients was 59284.52±5712.63 and 75128.77±10238.05 in the loop ileostomy group.In patients with mTICI,the period of protection of the anastomosis was 7.73±0.91 days.All the stoma were automatically closed after removal,and the automatic closure time of the stoma after extubation was 3.92±1.38 days.During the hospitalization and follow-up period,no anastomotic leakage occurred in either group.During the follow-up period,Three patients with parastomal hernia appeared in the loop ileostomy group,and one case of stoma collapse and stoma prolapse,there were no stoma-associated complications in the mTICI group.In addition,8 cases of anastomotic stenosis were found in the loop ileostomy group by reviewing colonoscopy.In the mTICI group,There were two case of postoperative complication related to the tubing site.The excrement overflowed from the cannula site,causing fecal dermatitis and delayed healing of the stoma.After strengthening changing dressing and using antibiotics,it healed after 1 week.Conclusion: 1.There was no anastomotic leakage occurred in either group,indicating that the mTICI can play the same role as the loop ileostomy in preventing anastomotic leakage.2.Compared with loop ileostomy,choosing mTICI can reduce the length of the postoperative stay,the hospitalization cost is low,the burden caused by the second surgery is avoided.3.It’s an alternative defunction stoma in the anus-preserving surgery for low rectal cancer.its short term efficacy is accurate and the long term efficacy needs further confirmation.