Comparison Of The Application Effects Of Laparoscopic Assisted Mid-Low Rectal Cancer Anterior Resection With Ileocecal Tubular Fistulation And Defunctioning Stoma

Objective.To compare the clinical application effects between ileocecal tubular fistulation and defuntioning stoma after laparoscopic assisted Dixon’s operation for middle or low rectal cancers.Methods.According to the established inclusion and exclusion criteria,64 cases of patients with mid-low rectal cancer from the Department of oncology surgery in our hospital from July 2016 to June 2018 were selected as the research objects.According to the the method of random number table,the patients were randomly divided into two groups,A and B,with 32 cases in each group.In group A,laparoscopic-assisted anterior resection of rectal cancer with ileocecal tubular fistulation was performed(tubular fistulation group);in group B,laparoscopic-assisted anterior resection of rectal cancer with defuntioning stoma was performed(defuntioning stoma group),and then stoma clousure was performed in secondary stage surgery.Basic clinical data of the two groups were compared,including quality of life before surgery and 3 months after surgery,intraoperative conditions,postoperative complications,postoperative pathological stages,hospitalization related indicators and specific complications.Results.There was no significant difference in basic clinical data between the two groups(P > 0.05).There was no significant difference in preoperative quality of life between the two groups(P > 0.05).However,the self-image and the expectation for the future in group A were all higher than those in group B after 3 months later of the operation,and the difference was statistically significant(P < 0.05).The total operative time of group A(200.93±11.87min)was significantly less than that of group B(252.96±17.81min),and the total intraoperative blood loss of group A(53.12±10.90ml)was also less than that of group B(70.02 5.02ml),with statistically significant difference(P < 0.05).Postoperative complications including anastomotic fistula,anastomotic bleeding,pulmonary infection and wound infection were not significantly different between the two groups.The length of hospital stay in group A(16.43±3.40 days)was significantly less than that in group B(22.21±3.12 days).Hospitalization expenses in group A(58426.37±6754.63 yuan)is less than group B(71531.68±5688.01 yuan),compare the difference was statistically significant(P < 0.05).Specific complications were occurred in group A with 2 cases tube blockage,and in group B 1 case had intestinal loops prolapse from the stoma,5 cases had wound infection after clousure,1 case had anastomotic bleeding and 1 case had anastomotic leakage after clousure.The incidence of postoperative complications was as high as 21.88%(7/32).Conclusions.The application of tubular fistulation under the low rectal cancer radical resection surgery has better security and feasibility.It can also obviously improve the patients quality of life,and reduce operative time and intraoperative blood loss,also reduce the in-hospital time and hospitalization costs,avoid colostomy and second phase of colostomy clousure related problem.So it’s worthy of clinical popularization and application.