A comparative study of ileal loop-type ileostomy and modified terminal ileum cannula ileostomy in anus preservation operation on low rectal cancer

doi:10.3877/cma.j.issn.2095-3224.2019.06.008

Abstract

Abstract:

Objective

Retrospective analysis of clinical datas of patients who underwent low rectal cancer (LRC) resection with modified terminal ileum cannula ileostomy (mTICI) or conventional ileal loop-type ileostomy, by comparing the clinical curative effects of the two groups, this study shall investigate the safety and efficacy of mTICI.

Methods

A total of 60 patients with low anterior resection for rectal cancer in Jiangsu Subei People′s Hospital from September 2016 to August 2018 were selected as the subjects of the study. Among them, twenty-five cases were treated with mTICI, and the other group was conventional ileal loop-type ileostomy (n=35), grouped according to defunction stoma. The datas of the two groups were compared and analyzed, including general and pathological datas, intraoperative and postoperative recovery datas, postoperative complications and follow-up results.

Results

No anastomotic leakage occurred in both groups after surgery. The length of the postoperative stay was (8.68±0.95) days in the mTICI group and (14.46±1.20) days in the loop ileostomy group, the difference between the two groups is statistically significant (t=13.00, P<0.01), including time for the initial and reversal operations. In the mTICI group, the total cost of patients were (59 284.52±5 712.63) and (75 128.77±10 238.05) in the loop ileostomy group, the difference between the two groups is statistically significant (t=6.99, P<0.01).

Conclusion

Compared with loop ileostomy, choosing mTICI can reduce the length of the postoperative stay, the hospitalization cost is low, the burden caused by the second surgery is avoided, and the same prevention as loop ileostomy can be achieved. It′s an alternative defunction stoma in the anus-preserving surgery for low rectal cancer.

Key words: Rectal neoplasms, Ileostomy, Low rectal cancer, Anastomotic leakage, Defunction stoma

Minghao Xu, Dong Tang, Wei Wang, Zhixiang Jin, Zhi Li, Qi Zhang, Xiaoqing Wu, Xiaoli Tang, Daorong Wang. A comparative study of ileal loop-type ileostomy and modified terminal ileum cannula ileostomy in anus preservation operation on low rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 588-595.

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References 24

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项目		改良自闭式造口组（25例）	回肠襻式造口组（34例）	χ²/t值	P值
年龄（岁）		61.52±10.30	59.74±9.31	0.90	0.49
性别		?	?	?	?
?	男	17	25	0.08	0.78
?	女	8	10	0.08	0.78
BMI（kg/m²）		23.94±2.81	24.16±2.16	0.35	0.73
腹部手术史		?	?	?	?
?	有	6	8	0.01	0.92
?	无	19	27	0.01	0.92
合并心肺脑疾病		?	?	?	?
?	有	10	12	0.21	0.65
?	无	15	23	0.21	0.65
合并糖尿病		?	?	?	?
?	有	2	4	0.00	1.00
?	无	23	31	0.00	1.00
ASA		?	?	?	?
?	Ⅰ	13	18	0.01	0.99
?	Ⅱ	9	13
?	Ⅲ	3	4

项目		改良自闭式造口组（25例）	回肠襻式造口组（34例）	χ²/t值	P值
年龄（岁）		61.52±10.30	59.74±9.31	0.90	0.49
性别		?	?	?	?
?	男	17	25	0.08	0.78
?	女	8	10	0.08	0.78
BMI（kg/m²）		23.94±2.81	24.16±2.16	0.35	0.73
腹部手术史		?	?	?	?
?	有	6	8	0.01	0.92
?	无	19	27	0.01	0.92
合并心肺脑疾病		?	?	?	?
?	有	10	12	0.21	0.65
?	无	15	23	0.21	0.65
合并糖尿病		?	?	?	?
?	有	2	4	0.00	1.00
?	无	23	31	0.00	1.00
ASA		?	?	?	?
?	Ⅰ	13	18	0.01	0.99
?	Ⅱ	9	13
?	Ⅲ	3	4

组别		改良自闭式造口组（n=25）	回肠襻式造口组（n=35）	χ²/t值	P值
肿瘤大小（cm）		5.84±1.55	6.03±1.34	0.500	0.62
肿瘤下缘距肛缘距离（cm）		4.68±0.90	4.49±0.89	0.83	0.41
清扫淋巴结（枚）		14（9，17.5）	12（9，16）	-0.26^*	0.80
转移淋巴结（枚）		0（0，1）	1（0，2）	-1.00^*	0.32
术后病理T分期		?	?	1.17	0.76
?	T₁	2	1	?	?
?	T₂	2	2	?	?
?	T₃	6	11	?	?
?	T₄	15	21	?	?
TNM分期		?	?	1.50	0.47
?	Ⅰ	2	2	?	?
?	Ⅱ	12	12	?	?
?	Ⅲ	11	21	?	?

组别		改良自闭式造口组（n=25）	回肠襻式造口组（n=35）	χ²/t值	P值
肿瘤大小（cm）		5.84±1.55	6.03±1.34	0.500	0.62
肿瘤下缘距肛缘距离（cm）		4.68±0.90	4.49±0.89	0.83	0.41
清扫淋巴结（枚）		14（9，17.5）	12（9，16）	-0.26^*	0.80
转移淋巴结（枚）		0（0，1）	1（0，2）	-1.00^*	0.32
术后病理T分期		?	?	1.17	0.76
?	T₁	2	1	?	?
?	T₂	2	2	?	?
?	T₃	6	11	?	?
?	T₄	15	21	?	?
TNM分期		?	?	1.50	0.47
?	Ⅰ	2	2	?	?
?	Ⅱ	12	12	?	?
?	Ⅲ	11	21	?	?

?	改良自闭式造口组（n=25）	回肠襻式造口组（n=35）	t值	P值
手术时间（min）	164.6±28.97	163±30.78	0.20	0.84
造口时间（min）	27.32±7.07	28.86±4.55	1.03	0.31
出血量（mL）	49.4±25.26	45.29±23.29	0.65	0.52
肠功能恢复时间（天）	2.08±0.7	1.89±0.63	1.12	0.27
进食时间（天）	2.68±0.58	2.43±0.50	1.83	0.07
术后住院时间（天）	8.00±1.38	15.83±2.77	13.00	<0.01
住院总花费（元）	59 284.52±5 712.63	75 128.77±10 238.05	6.99	<0.01

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