An Observational Study On Anal Function And Quality Of Life After TaTME Combined With Modified Bacon Operation

Background:Transanal total mesorectal excision(taTME)has become a hot spot in the surgical treatment of patients with low rectal cancer.On the other hand,because the tumor is close to the anal margin,anastomotic leakage also occurs more frequently.When the method of "no anastomosis" is adopted in the reconstruction of tatme digestive tract,the combination of tatme and modified bacon operation can avoid the occurrence of anastomotic leakage.The treatment goal of rectal cancer is to prolong the survival of patients and improve the quality of life.At present,medical treatment has changed from "disease-centered" to "patient-centered".While treating the disease itself,we should pay more attention to the patients’ quality of life,psychological state and related social factors.Therefore,comprehensive nursing for patients plays an extremely important role in the whole treatment process.However,the postoperative anal function and quality of life of the new combined operation of tatme combined with modified bacon are still unclear.Objection:To observe the anal function and quality of life of patients undergoing tatme combined with modified bacon operation,so as to provide reference basis for formulating comprehensive nursing measures for patients undergoing new combined operation.Method:The clinical data of patients with rectal cancer who underwent taTME in a hospital from March 2020 to July 2021 were collected.The patients who received taTME combined with modified Bacon surgery were the observation group(n=31),and the patients who underwent taTME anastomosis directly were the control group(n=43).Main outcome measures:Anal function and quality of life at 1,3,and 6 months after surgery.The former was assessed by the LARS scale and the Wexner incontinence scale,the latter was assessed by the EORTC QLQ-C30 scale and the EORTC QLQ-CR29 scale.Secondary outcome measures were operation time,intraoperative blood loss and incidence of perioperative complications.Results:1.In terms of anal function,there was no significant difference between the observation group and the control group in the LARS scale scores at 1,3,and 6 months after the operation(P>0.05);the observation group and the control group at 1,3,and 6 months after the operation.There was no significant difference between Wexner incontinence scores(P>0.05).2.In terms of quality of life,the difference between the observation group and the control group in the emotional function sub-item of the EORTC QLQ-C30 scale 6 months after surgery was statistically significant(P<0.05).There were statistically significant differences between the observation group and the control group in the sub-items of EORTC QLQ-CR29 scale anal pain,frequent defecation and defecation embarrassment at 1 month after operation(P<0.05).3.In terms of perioperative indicators,the operation time of the observation group and the control group were 261.68min and 250.02min,respectively,and the intraoperative blood loss was 74.52ml and 73.95ml,respectively.There was no significant difference between the two groups in these two indicators.The hospitalization time of the observation group and the control group was 18.13d and 12.74d respectively,and the difference between the two groups was statistically significant(P<0.001).4.For postoperative complications,there were 2 cases of pulmonary infection in the observation group,but no anastomotic leakage.In the control group,there were 2 cases of anastomotic leakage,1 case of pelvic hemorrhage,1 case of pulmonary infection and 2 cases of urinary retention,but both groups were cured and discharged after conservative treatment.Conclusion:1.Compared with direct anastomosis after taTME,taTME combined with modified Bacon is safe and feasible,avoiding the occurrence of anastomotic leakage,but prolonging the hospitalization time of patients.2.Compared with the direct anastomosis after taTME,the anal function after taTME combined with modified Bacon did not decrease significantly.3.Compared with the direct anastomosis after tatme,the quality of life after tatme combined with modified bacon is lower,which is mainly reflected in anal pain,frequent defecation,awkward defecation and emotional function.It is necessary to further formulate comprehensive nursing measures for intervention.