Zhang Xuena, Meng Qingyu, Du Jianna, Tian Zhongtao, Li Yinju, Yu Bin, Niu Wenbo
Department of Nursing, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, China.
Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, China.
BMC Gastroenterol. 2025 Jan 23;25(1):32. doi: 10.1186/s12876-025-03614-7.
The relationship between high-output stoma (HOS) and low anterior resection syndrome (LARS) was previously unclear. This study investigated the association between HOS and major LARS in rectal cancer patients with preventive stoma.
We conducted a retrospective analysis of 653 rectal cancer patients who underwent prophylactic ileostomy reversal after low anterior resection at the Fourth Hospital of Hebei Medical University between 2018 and 2021. Patients were categorized into HOS and non-HOS groups based on stoma output within 3 months before surgery. Major LARS was assessed using the LARS score. The association between HOS and major LARS was analyzed using multifactor logistic regression models, subgroup analyses, and smoothing curve fitting methods.
Among the 653 patients, 53 (8.1%) experienced HOS, and 81 (12.4%) developed major LARS after stoma closure. The HOS group exhibited a significantly higher risk of major LARS compared to the non-HOS group (P < 0.001). Multivariate logistic regression indicated that HOS was associated with a 210% increased risk of major LARS (OR: 3.10; 95% CI: 1.56, 6.14; P = 0.001). Subgroup analysis revealed that this association was more pronounced in older patients (age > 60), those without hypertension, with N0-N1 staging, a history of chemotherapy, and longer stoma closure intervals (Q3, Q4).
HOS is significantly associated with major LARS in rectal cancer patients, particularly in certain clinical subgroups. These findings suggest the need for careful management of HOS to potentially reduce LARS occurrence after stoma closure.
高输出量造口（HOS）与低位前切除综合征（LARS）之间的关系此前尚不明确。本研究调查了直肠癌预防性造口患者中HOS与重度LARS之间的关联。
我们对2018年至2021年在河北医科大学第四医院接受低位前切除术后预防性回肠造口还纳术的653例直肠癌患者进行了回顾性分析。根据术前3个月内的造口输出量将患者分为HOS组和非HOS组。使用LARS评分评估重度LARS。采用多因素逻辑回归模型、亚组分析和平滑曲线拟合方法分析HOS与重度LARS之间的关联。
在653例患者中，53例（8.1%）出现HOS，81例（12.4%）在造口关闭后发生重度LARS。与非HOS组相比，HOS组发生重度LARS的风险显著更高（P < 0.001）。多因素逻辑回归表明，HOS与重度LARS风险增加210%相关（比值比：3.10；95%置信区间：1.56，6.14；P = 0.001）。亚组分析显示，这种关联在老年患者（年龄>60岁）、无高血压患者、N0 - N1分期患者、有化疗史患者以及造口关闭间隔时间较长（Q3、Q4）的患者中更为明显。
HOS与直肠癌患者的重度LARS显著相关，尤其是在某些临床亚组中。这些发现表明需要对HOS进行仔细管理，以潜在降低造口关闭后LARS的发生。
