Comparison of the Effects of Indwelling Anal Canal and Terminal Ileostomy in Preventing Anastomotic Fistula after Middleand Low Anterior Rectal Resection/WU Junchao，SHAO Qi，LUO Yunxia，LIFei.//MedicalInnovationofChina，2025，22（19）：023-027

[Abstract]Objective：To compare the efects of indwelling anal canal and terminal ileostomy in preventing anastomotic fistula after middleand low anterior rectal resection.Method： A retrospective study was conducted on 120 patients who underwent middleand low anterior rectal resection in Jurong People's Hospital from January 2022 to August 2O24.They were divided into the control group and the study group according to different methods for preventing anastomoticfistula aftersurgery，with 6O cases ineach group.Inthe control group，theanal canal was indwelld to prevent postoperativeanastomotic fistula，while inthe study group，terminal ileostomy was performed to prevent postoperative anastomotic fistula.Compared the incidence of postoperative anastomotic fistula and the incidence ofcomplicationsbetween the two groups;compared theoperation time，intraoperative blood lossvolume， postoperative intestinal function recovery time （exhausttime，resumptionof eating time），hospital stay and treatment cost of the two groups; compared the degree of postoperative pain and the levels of inflammatory factors between thetwo groups.Result：Therewere no statistically significant diffrences in the incidence of anastomotic fistula and complications after surgery between the two groups （ P gt;0.05）. The operation time and hospital stay of the study group were longer than those of the control group，the treatment cost was higher than thatof the control group，and the exhaust time and the resumption of eating time were earlierthanthoseof the control group，the diffrences were statistically significant （ P lt;0.05）.There was no statistically significant difference in the intraoperative blood loss between the two groups （ Pgt;0.05 ）. At 12，24，36 and 48 hours after the operation，the VAS scores of the study group were lower than those of the control group，the differences were statistically significant （ P lt;0.05）. At 1，3 and 5 d after theoperation，thelevels of inflammatory factors inthe study group were all lower than those in the control group， the differenceswere statistically significant （Plt;0.05） ）.Conclusion：After middle and low anterior rectal resection， the regimensof indweling analcanal and terminal ileostomy forpatients havecomparable effects in preventing anastomotic fistula，each with its own advantages and disadvantages.

[Key Words]Rectal cancerMiddle and low anterior rectal resectionAnastomotic fistulaIndweling anal canalTerminal ileostomy

First-author'saddress：DepartmentofGeneralSurgery，JurongPeople'sHospital，Jurong212400， China

doi：10.3969/j.issn.1674-4985.2025.19.006

直肠癌是常见的消化道恶性肿瘤疾病，病灶发生于直肠黏膜上皮。该病早期通常没有症状，后期出现大便形状及排便习惯的改变，例如便意频繁、便中带血及黏液、腹痛、腹胀及排便前肛门下坠感、排便不尽等]。患者年龄范围主要是40＼～80 岁，男性比女性发病率高。该病最常见病理类型是腺癌，腺鳞癌与未分化癌相对少见[2。目前，临床治疗直肠癌的根本原则是个体化综合治疗，主要治疗方案是手术，多数患者术后可以长期生存，预后较好[3]。中低位直肠前切除术近年来临床应用较多，能够保留患者正常排便功能，慰藉患者精神，获得比较好的应用效果，得到患者较高的满意度与认可度[4。但是，在手术操作影响下，患者术后容易出现吻合口漏，增加患者术后恢复难度，延长康复时间，并且可能需要进行二次手术，给患者造成二次伤害、增加治疗费用[5。随着医疗技术水平不断提高，临床上对直肠癌患者做中低位直肠前切除术时，可以采取有效措施预防术后吻合口漏，提高手术成功率，加快术后康复，降低并发症发生率。留置肛管与末端回肠造瘘是现阶段应用比较多、效果较好的两种预防术后吻合口瘘方案。两种预防方案各有优势和不足，临床应用时需要从患者实际情况（身体状况、病情等）出发，选择合适的方案进行使用，以此获得理想的效果，降低术后吻合口瘘发生率，促进患者术后康复，尽快出院。为了降低患者术后吻合口瘘的概率，探究留置肛管与末端回肠造瘘实际应用操作方法、效果至关重要，从而明确操作要点、优化操作流程。……