| Objective: To explore the appropriate time to accept the closure of stoma in patients with prophylactic stoma after low rectal cancer surgery.Methods: In the first part,the general data and follow-up data of 106 patients with low rectal cancer were analyzed retrospectively from January 2018 to December 2019 in Tongji Medical College of Huazhong University of Science and Technology.The incidence of postoperative complications and related scores were compared.In the second part,the tissues of the ileal wall of the patients with low rectal cancer were collected before and after the operation.The relative content of type I and type III collagen in tissues was determined by Western Blot.And the difference of collagen was compared,so as to speculate the right timing for the closure of the stoma.Results:(1)In the retrospective analysis of 106 cases,there were 8 cases of preoperative complications in group A(short-term recovery group),the incidence was 19.51%.There were 29 cases in group B(delayed recovery group),the incidence was 44.61%.The incidence of complications in group B was significantly higher than that in group A(P <0.05).There were 17 cases of postoperative complications in group A,the incidence was 41.46%.In group B,30 cases(46.15%)had postoperative complications.In other words,no significant difference was found in the incidence of the complications between group A and group B.(2)Single factor analysis and multi factor analysis were carried out for postoperative incision infection and electrolyte disorder,among which basic diseases and operation time was more than 90 minutes were the independent risk factors for postoperative incision infection.Gender,age,BMI,basic disease,operation time,time of stoma reservation,distance between tumor and anal margin,adjuvant treatment,tumor area and tumor pathological stage were not related to electrolyte disorder.(3)Three months after discharge from the hospital,the subjective feeling score of stoma life in group A was 30.46±2.53,that in group B was 24.35±2.03.In the quality of life score,the total score of group A was 105.1±10.38,and the total score of group B was 94.6±7.18,both of which had statistical difference.(4)The results of Western blot showed that in the mucosal layer,t = 10.244,P = 0.001 < 0.05 in group A.It implied that the relative content of collagen in the mucosal layer of group A was significantly higher than that before operation.t = 2.374,P = 0.077 > 0.05 in group B,that is,there was no significant difference in the collagen in the mucosal layer of group B before and after operation.In the sarcoplasmic layer,t = 19.605,P = 0.000 < 0.05 in group A.It implied that the relative content of collagen in the sarcoplasmic layer of group A was significantly higher than that before operation.t = 2.640,P = 0.058 > 0.05 in group B,that was to say,there was no significant difference in the sarcoplasmic layer of group B before and after operation.Conclusion:(1)The results of retrospective analysis shows that prophylactic terminal ileostomy within 90 days after operation,can reduce the incidence of complications related to preoperative ostomy,but does not increase the incidence of recent postoperative complications related to ostomy.At the same time,it can improve the subjective feeling and the quality of life of patients.(2)The results of Western Blot shows that the collagen of intestinal tissue was significantly higher in the patients who received the closure of the stoma within 4 weeks than before,but there was no significant difference in the patients who received that within 4-8 weeks,which indirectly reflected that the mechanical strength of the intestinal wall of the former was higher than that of the latter.Therefore,we preliminarily speculated that 4 weeks might be a more suitable time for the closure of the stoma. |
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