| Objective:The aim of this study was to compare the effects of prophylactic transileal prophylactic stoma antegrade enema and transanal retrograde enema on the occurrence of postoperative anterior resection syndrome and defecation function in patients with middle and low rectal malignant tumors who underwent sphincter-preserving surgery.To explore a safe and effective treatment and preventive measure for the occurrence and development of abnormal anal defecation function and anterior resection syndrome in patients with rectal malignant tumor after sphincter-preserving surgery.Methods:A prospective randomized controlled clinical study design was used to select 60 patients who underwent rectal sphincter-preserving surgery and preventive ileostomy for rectal malignant tumors in the Gastrointestinal Department of Qingdao University Affiliated Hospital from September 2019 to January 2022.They were randomly divided into antegrade enema group through ileostomy(group A),retrograde enema group through anus(group B)and control group(group C),20 cases in each group.After the 6th week after rectal sphincter preservation,antegrade enema treatment and retrograde enema treatment were started respectively.The control group was given postoperative diet adjustment,anus dilation and other conventional treatments,and the enema was stopped after the stoma was restored.Collect the basic clinical data of patients(such as gender,BMI,distance from the lower edge of the tumor to the anal verge,age,neoadjuvant therapy before and after surgery,tumor stage,etc.)Follow-up data related to the LARS scale and Wexner fecal incontinence scale at the 1st,3rd,and 6th months after surgery.By comparing the three groups of patients with rectal malignant tumor before sphincter-preserving surgery,the first month after preventive ileostomy surgery,the third month after preventive ileostomy surgery,and preventive ileostomy surgery The LARS and Wexner scale scores were compared at the 6th month after surgery to compare the occurrence of anterior resection syndrome and the changes in defecation function after rectal sphincter-preserving surgery.Results:1.By comparing the basic clinical data of the three groups of follow-up patients,gender,BMI,distance between the lower edge of the tumor and the anal verge,age,preoperative and postoperative neoadjuvant therapy,and tumor pathological staging among the three groups of follow-up patients The difference was not statistically significant(P>0.05).2.Incidence of LARS:At 1 month after surgery,there was a statistically significant difference in the incidence of LARS among the three groups,P=0.014;at 3 months after surgery,there was a statistically significant difference in the incidence of LARS among the three groups,P=0.039 6 months after stoma resection,there was a statistically significant difference in the occurrence of LARS among the three groups,P=0.025.3.LARS score:1 month after ostomy resection,the LARS score of patients in group A was 34.2±8.1,The LARS score of the follow-up patients in group B was 32.1±4.6,and the LARS score of the follow-up patients in group C was 38.4±2.4.Pairwise comparison showed that there was no significant difference between the antegrade enema group(group A)and the retrograde enema group(group B)(p=0.747),the antegrade enema group(group A)and the control group(group C),retrograde The comparison between the enema group(group B)and the control group(group C)showed that there was a statistical difference(p<0.001,p=0.002).Under the condition of 3 months after stoma resection,the LARS score of follow-up patients in group A was 26.9±8.9,the LARS score of follow-up patients in group B was 26.3±2.7,and the LARS score of follow-up patients in group C was 33.8±2.1.Pairwise comparison showed that there was no significant difference between the antegrade enema group(group A)and the retrograde enema group(group B)(p=0.893),the antegrade enema group(group A)and the control group(group C),retrograde The comparison between the enema group(group B)and the control group(group C)showed that there was a statistical difference(p=0.001,p<0.001).Under the condition of 6 months after stoma resection,the LARS score of follow-up patients in group A was 17.2±7.0,the LARS score of follow-up patients in group B was 13.5±3.5,and the LARS score of follow-up patients in group C was 23.6±2.4.Pairwise comparison showed that there was no significant difference between the antegrade enema group(group A)and the retrograde enema group(group B)(p=0.460),the antegrade enema group(group A)and the control group(group C),retrograde The comparison between the enema group(group B)and the control group(group C)showed that there was a statistical difference(p<0.001,p<0.001).4.Wexner score:under the condition of 1 month after stoma resection,the Wexner score of the follow-up patients in group A was 9.6±2.4,the Wexner score of the follow-up patients in group B was 8.5±2.7,and the Wexner score of the follow-up patients in group C was 12.1±2.7 1.2.Pairwise comparison showed that there was no significant difference between the antegrade enema group(group A)and the retrograde enema group(group B)(p=0.352),and the antegrade enema group(group A)and the control group(group C),retrograde The comparison between the enema group(group B)and the control group(group C)showed that there was a statistical difference(p=0.002,p<0.001).At 3 months after stoma resection,the Wexner score of the follow-up patients in group A was 5.2±1.6,that of group B was 4.6±1.4,and that of group C was 9.2±1.3.Pairwise comparison showed that there was no significant difference between the antegrade enema group(group A)and the retrograde enema group(group B)(p=0.500),and the antegrade enema group(group A)and the control group(group C),retrograde The comparison between the enema group(group B)and the control group(group C)showed that there was a statistical difference(p<0.001,p<0.001).At 6 months after stoma resection,the Wexner score of the follow-up patients in group A was 2.9±1.0,that of group B was 2.4±0.9,and that of group C was 5.4±1.2.Pairwise comparison showed that there was no significant difference between the antegrade enema group(group A)and the retrograde enema group(group B)(p=0.378),the antegrade enema group(group A)and the control group(group C),retrograde The comparison between the enema group(group B)and the control group(group C)showed that there was a statistical difference(p<0.001,p<0.001).Conclusion:This study shows that most patients have different degrees of anterior resection syndrome after sphincter-preserving surgery for middle and low rectal malignant tumors.Anterior resection and retrograde enema treatment can reduce the occurrence of anterior resection syndrome to a certain extent,and reduce the anterior resection syndrome.However,the comparison of antegrade enema and retrograde enema showed that there was no significant difference in the treatment effect between the two,indicating that antegrade enema and retrograde enema Enema is an effective treatment for improving the symptoms of anterior resection syndrome and the recovery of anorectal function in patients after rectal sphincter preservation. |
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