Analysis Of The Effect Of Different Anastomotic Position On Anal Function After Laparoscopic Rectal Cancer Surgery

Objective: To study the effect of different anastomotic position on anal function after laparoscopic rectal cancer surgery.Method:60 patients(28 female and 32 male)who underwent laparoscopic rectal cancer surgery in Qingdao Municipal Hospital affiliated to Qingdao University from April 2017 to January 2020 were selected.The same laparoscopic rectal surgery was performed,sphincter-preserving Dixon procedure was selected,and the stapler diameter was 29 mm.The patients were divided into groups according to the distance between the rectal anastomosis and the anal margin,in which the distance between the anastomotic stoma and the anal margin was measured by finger diagnosis combined with electronic endoscope,which was expressed by H.In group A,the distance from the anastomotic stoma to the anal margin H ≤ 3cm.In group B,the distance from anastomosis to anus was 3cm ≤ H ≤ 5cm.In group C,the distance from the anastomosis to the anus was H ≥ 5cm but below the peritoneal reflex.At the same time,20 patients with descending colon and sigmoid colon who underwent laparoscopic minimally invasive surgery in our hospital(11 males and 9 females)were selected as the control group,In the control group,the anastomotic site was higher than the peritoneal reflex.All the patients in the above four groups were less than 70 years old,and there were no other basic diseases that might affect the anal function before operation.The anal function of all the above-mentioned patients was monitored before operation,3 months after operation and 1 year later.Three values of anal resting pressure(ARP),effective length of anal sphincter high pressure zone(EL)and maximum anal coarctation pressure(MSP)were selected,and the changes of anal manometry data 3 months before and one year after operation were statistically analyzed by t-test.And the data changes of each group and the control group,using t-test.P < 0.05 was regarded as the standard of statistical difference.Result: According to the data of anal manometry,it can be concluded that: 1.There was no significant difference in anal resting pressure,effective length of anal sphincter high pressure zone and maximum anal sphincter coarctation pressure between group A,group B and group C compared with the control group(P > 0.05).2.Three months after operation,the anal resting pressure,the effective length of anal sphincter high pressure zone and the maximum narrowing pressure of anal sphincter in group An and group B were significantly lower than those befor operation(P <0.05).3.In group A,the maximum anal sphincter compression pressure was close to the normal value one year after operation,but the anal resting pressure and the effective length of anal sphincter high pressure zone were still lower than those before operation(p < 0.05).4.One year after operation,the anal resting pressure,the effective length of anal sphincter high pressure zone and the maximum narrowing pressure of anal sphincter in group B all returned to normal(p > 0.05).5.3 months after operation,the three indexes of rectal cancer patients in group C were close to the normal value(P > 0.05).6.The results of the patients in the control group were close to the normal value 3 months after operation(p > 0.05).Conclusion: Under the condition of strictly standardizing the enrollment criteria and adopting the current advanced and unified minimally invasive operation methods and basically the same surgical instruments,patients with laparoscopic rectal cancer whose anastomosis is about 3 cm or more from the anus can basically restore normal anal function one year after operation.in addition,the anal function of patients with rectal cancer whose anastomosis is more than 5 cm can be restored within 3 months after operatio.