Effect Of Laparoscopic Transanal Total Mesorectal Excision And Laparoscopic Total Mesorectal Excision On Coagulation Function In Patients With Rectal Cancer

Objective: To investigate the effect of Laparoscopic Transanal Total Mesorectal Excision(Lap-Ta-TME)and Laparoscopic Total Mesorectal Excision(Lap-TME)on coagulation function in patients with rectal cancer during perioperative period.Methods: A retrospective study was conducted on 82 patients with rectal cancer treated in our department from September 2016 to September2018.Lap-Ta-TME group was performed in 40 cases and Lap-TME group in 42 cases.There were no significant differences in age,sex,body mass index,distances from the lower edge of the tumor to the dentate line,ASA classification,operation time and intraoperative blood loss between the two groups(P > 0.05).The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),fibrinogen degradation products(FDP),D-dimer(D-D)and platelet(PLT)were measured before operation,1-24 hours after operation and 24-72 hours after operation,and the results were analyzed and compared.Results:There was no significant difference in PT,APTT,TT,FIB,FDP,D-D and PLT between the observation group and the control group(P > 0.05).The PLT group decreased 1-24 hours after operation and 24-72 hours after operation(P < 0.05),but there was no significant difference between 24-72 hours after operation and 1-24 hours after operation.The levels of PT and TT at 1-24 h and 24-72 h after operation in the two groups had no significant changes compared with those before operation(P > 0.05),and the levels of PT and TT at 24-72 h after operation had no significant difference compared with those at 1-24 h after operation(P > 0.05).The APTT of the two groups at 1-24 hours after operation was longer than that before operation,and the difference was statistically significant(P < 0.05).The APTT value at 24-72 hours after operation was not significantly different from that at 1-24 hours after operation(P > 0.05).There was no significant difference in FIB between the two groups 1-24 hours after operation(P > 0.05),but it increased between the two groups 24-72 hours after operation(P < 0.05).There was a significant difference in FDP between the two groups at 1-24 hours and 24-72 hours after operation(P <0.05),but there was no significant increase in FDP between the two groups at 24-72 hours after operation compared with that at 1-24 hours after operation.The levels of D-D in the two groups were significantly higher than those before operation(P < 0.05),and the levels of D-D in the 24-72 hours after operation were significantly higher than those in the 1-24 hoursafter operation(P < 0.05).Conclusion: Laparoscopic Total Mesorectal Excision(Lap-TME)and Laparoscopic Transanal Total Mesorectal Excision(Lap-Ta-TME)for rectal cancer can cause hypercoagulable state of blood,which may lead to deep vein thrombosis or pulmonary embolism.However,Laparoscopic Transanal Total Mesorectal Excision(Lap-Ta-TME)has no greater impact on coagulation than Laparoscopic Total Mesorectal Excision(lap-TME)for rectal cancer.Therefore,perioperative prevention of deep venous thrombosis or pulmonary embolism should be actively taken in both types of operation,but Laparoscopic Transanal Total Mesorectal Excision(Lap-Ta-TME)patients need not actively increase anticoagulation therapy compared with conventional Laparoscopic Total Mesorectal Excision patients.