Abstract: Ileostomy for protecting lowrectalanastomosiscanreduce thereo perationrateand the in cidence and mortality of anastomoticleakage，and isbeneficialtoalleviatelow anteriorresectionsyndrome.However，protective ileostomy significantly increases the postoperative complications of ileostomy，affecting the quality of life and the risk of operation.Indications for protective ileostomy：the lower margin of the rectal tumor is 6 to 7 cm from the anal margin.Preoperative neoadjuvant chemoradiotherapy，poor intestinal preparation，unsatisfactory anastomosis and large anastomotic tension，preoperative history of diabetes，hypoalbinemia，patients and their families can not withstand the second surgical blow after anastomotic leakage.The risk grade of anastomotic leakage in rectal cancer preresection can accurately evaluate the risk of anastomotic leakage in patients，and it is easy to grasp the indications of protective ileostomy.New approaches to protective ileostomy include virtual ileostomy and balloon catheter ileostomy without the need for reentrant ileostomy.These procedures can improve the patient's quality of life and reduce complications.Complications of protective ileostomy include ileostomy complications，disuse enteritis，acute kidney injury and severe kidney disease，and non-retentive of protective ileostomy.Protective ileostomy should be selected rationally in low rectal tumor preservation operation.Protective ileostomy should not be used routinely，nor should it be used routinely.

Key words: low rectal cancer, rectal anastomotic leakage, Ileostomy