Analysis Of The Application Of Laparoscopic Low Anterior Resection Combined With Defunctioning Stoma For Rectal Cancer

OBJECTIVE: To investigate the feasibility and clinical effect of combined defunctioning stoma in laparoscopic low anterior resection of rectal cancer.METHODS: The clinical data of 85 patients with middle and low rectal cancer treated in the Department of Colorectal Surgery of the First Affiliated Hospital of Guangxi Medical University from January 2018 to December 2018 were analyzed retrospectively.According to the mode of operation,the patients were divided into observation group(n = 40)and control group(n = 45).Laparoscopic low anterior resection of rectal cancer was performed under the guidance of ERAS in both groups during perioperative period,defunctioning stoma was performed in the observation group.The clinical data of the two groups were analyzed and compared,including operation time,intraoperative blood loss,postoperative first anal exsufflation time,first eating time,postoperative hospital stay,anastomotic leakage and other complications.RESULTS: The operation time between the observation group and the control group was(234.83 ±94.20)min and(207.84 ±63.69)min,respectively.The intraoperative bleeding volume was(65.50 ±62.06)ml and(58.89 ±47.44)ml,respectively.There was no significant difference in operation time andbleeding volume between the observation group and the control group(P > 0.05).There was no significant difference in operation time and bleeding volume between the observation group and the control group(P > 0.05).The first exhaust time of the two groups was(2.98 ±1.79)days and(4.91 ±3.53)days,and the first eating time was(2.80 ±1.76)days and(5.76 ±4.86)days,respectively.the postoperative hospital stay was(7.08 ±2.03)days and(14.33 ±11.43)days,respectively.the first exhaust time,the first eating time and the postoperative hospital stay in the observation group were better than those in the control group.The difference was statistically significant(P < 0.05).The incidence of anastomotic leakage was 5% in the observation group and 17.8% in the control group.There was no significant difference in the incidence of anastomotic leakage between the two groups(P > 0.05).The incidence of secondary operation was 0% in the observation group and 13.3% in the control group.The secondary operation rate in the observation group was significantly lower than that in the control group(P < 0.05).The incidence of postoperative complications was 17.5% in the observation group and 48.9% in the control group(P < 0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(P <0.05).The incidence of postoperative complications was 17.5% in the observation group and 48.9% in the control group(P < 0.05).The incidence of postoperative complications after II operation in the observation group was12.5%.The overall incidence of postoperative complications was 27.9% in the observation group and 48.9% in the control group.The overall postoperative complications in the observation group were significantly lower than those in the control group(P < 0.05).CONCLUSIONS: In laparoscopic low anterior resection of rectal cancer,intraoperative combined with defunctioning stoma can speed up the recovery of patients.Defunctioning stoma can not reduce the incidence of anastomotic leakage,but it can reduce the severity of anastomotic leakage and reduce the rate of secondary operation.