区域引流在完全腹腔镜全胃手术后瘘并发症诊疗中的应用  

Application of regional drainage in the diagnosis and treatment of fistula complications after totally laparoscopic total gastric surgery

作　　者：张迎峰 蒋恒[1] 方征[2] 周连帮[1] ZHANG Ying-feng;JIANG Heng;FANG Zheng(Department of General Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of General Surgery,the First Affiliated Hospital of Anhui Medical University)

机构地区：[1]安徽医科大学第二附属医院普通外科,安徽合肥230601 [2]安徽医科大学第一附属医院普通外科

出　　处：《腹腔镜外科杂志》2022年第10期740-743,共4页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金(81902456)。

摘　　要：目的:探讨区域引流在完全腹腔镜全胃手术后瘘并发症诊疗中的应用价值。方法:回顾分析2016年11月至2020年2月为280例胃癌患者行完全腹腔镜全胃切除术的临床资料。术中根据胃的4支固有血管及系膜的集束化分布特点,将术野“区域化”后放置引流管,对引流管相关指标进行研究。结果:本研究共纳入280例患者,25例发生瘘,其中吻合口漏2例(0.7%)、十二指肠残端漏15例(5.4%),胰瘘8例(2.9%)。吻合口漏、十二指肠残端漏、胰瘘组间引流管相关指标(引流管侧别、引流液性状、日均引流量、伴随症状)差异均有统计学意义(P<0.05);瘘患者与未发生瘘患者留置引流管时间[(24.1±5.7)d vs.(6.6±1.5)d,P<0.05]、管周疼痛(5 vs.1,P<0.05)、拔管困难(2 vs.0,P<0.05)差异均有统计学意义;留置引流管后腹痛(1 vs.0,P>0.05)差异无统计学意义。患者均未发生拔管断裂或疝。结论:全胃手术后准确放置引流管建立区域引流是必要且安全的,掌握其规律对瘘并发症的诊断与治疗具有指导意义。Objective:To evaluate the application value of regional drainage in the diagnosis and treatment of fistula complications after totally laparoscopic total gastric surgery.Methods:The clinical data of 280 gastric cancer patients who underwent totally laparoscopic total gastrectomy from Nov.2016 to Feb.2020 were retrospectively analyzed.Intraoperative drainage tubes were placed after the"regionalization"of the surgical field according to the clustering distribution characteristics of the 4 inherent gastric vessels and the mesentery,and the indicators related to the drainage tubes were studied.Results:A total of 280 patients were included in this study,25 patients suffered from fistula,including 2 cases of anastomotic leakage(0.7%),15 cases of duodenal stump leakage(5.4%),and 8 cases of pancreatic fistula(2.9%).There were statistically significant differences in drainage tube related indicators(drainage tube side,drainage fluid properties,daily drainage amount and accompanying symptoms)among patients with anastomotic leakage,duodenal stump leakage and pancreatic fistula(P<0.05).The difference was statistically significant in duration of indwelling drainage tube[(24.1±5.7)d vs.(6.6±1.5)d,P<0.05],pain around the tube(5 cases vs.1 case,P<0.05),extubation difficulty(2 cases vs.0 case,P<0.05)between fistula patients and general patients;the difference in abdominal pain after indwelling drainage tube(1 vs.0,P>0.05)was no statistically significant.No extubation ruptures or hernias occurred in all patients.Conclusions:Accurate placement of drainage tube is necessary and safe to establish regional drainage after total gastric surgery.Mastery of the rules is of guiding significance for the diagnosis and treatment of fistula complications.

关 键 词：胃肿瘤 胃切除术 腹腔镜检查 瘘 区域引流 

分 类 号：R735.2[医药卫生—肿瘤]