Clinical Study On The Application Of Anastomotic Reinforcement Suture Combined With Pelvic Floor Peritoneal Reconstruction In Laparoscopic Anterior Resection Of Rectal Cancer

Objective:To explore the role of anastomotic reinforcement suture combined with pelvic floor peritoneal reconstruction in preventing anastomotic leakage and other complications after laparoscopic anterior resection of rectal cancer,and guide future clinical work.Methods:A total of 238 patients who had undergone laparoscopic anterior resection for rectal cancer were selected from the Department of Gastrointestinal and colorectal surgery,Jilin University china-japan Friendship Hospital from October 2020 to October 2022.The patients were divided into two groups according to the different operation methods: 113 cases were treated with anterior resection of the rectum combined with stapling and suturing of anastomotic stoma and reconstruction of pelvic floor peritoneum,125 patients underwent only laparoscopic anterior rectal resection were selected as the control group.All patients received routine preoperative preparation.Three days before surgery,all patients were given oral anti-inflammatory drugs(levofloxacin,gentamicin,metronidazole).One day before surgery,a Central venous catheter was placed and bowel preparation was done.The common bowel preparation method is to take 2L of Polyethylene glycol solution orally within 4-6 hours to remove watery stool.In addition,dietary fiber is gradually reduced before operation.In some patients,laxatives(lactulose or Senna)are used instead,the operation morning clean enema completes the intestinal tract to prepare after the attention to give the parenteral nutrition treatment.To correct possible disturbances in the water,water-electrolyte imbalance,and acid-base balance.An indwelling catheter is helpful to monitor urine volume during operation.Standard laparoscopic total mesorectal excision(TME)was performed in both groups.Observation indicators: 1.The clinical data and postoperative recovery were compared between the two groups;2.To analyze the risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.Results:1.Compared with the control group,the first exhaust time,first out-of-bed activity time,gastrointestinal function recovery time,and postoperative hospital stay in the observation group were significantly shorter(p<0.05);2.Compared with the control group,the operation time in the observation group increased significantly(p<0.05);3.The levels of WBC,neutrophil,monocyte,lymphocyte,and c-reactive protein in the observation group were significantly lower than those in the control group,the difference was significant(p<0.05);4.The incidence of postoperative complications in the observation group was significantly lower than in the control group.The incidence of anastomotic leakage and adhesive intestinal obstruction in the observation group was significantly lower than that in the control group,the difference was significant(p<0.05);5.The results of the univariate analysis showed that age,sex,diabetes mellitus,tumor diameter,the distance between tumor and anal margin,tumor stage,suture reinforcement,and reconstruction of the pelvic floor and peritoneum were the related factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer(p<0.05);6.Multivariate analysis showed that tumor diameter≧4cm and tumor distance≦5cm were independent risk factors for postoperative anastomotic leakage,while anastomotic reinforcement and suture combined with pelvic floor and peritoneal reconstruction were independent protective factors.Conclusions:The anastomotic reinforcement and suture combined with pelvic floor peritoneal reconstruction in laparoscopic middle and low rectal cancer anterior resection can accelerate the recovery of gastrointestinal function and reduce the inflammatory reaction of postoperative patients,in operation,the procedure of anastomotic reinforcement and suture combined with pelvic floor peritoneal reconstruction takes a certain amount of time.It prolongs the operation time Anastomotic support and suture combined with pelvic floor and peritoneal reconstruction were the independent protective factors for postoperative anastomotic leakage.The diameter of the tumor ≥4 cm and the distance between the tumor and the anal margin ≤5 cm were the independent risk factors for postoperative anastomotic leakage.