术中吻合口测试技术在预防胃癌术后吻合口漏中的研究进展  

Research progress of intraoperatively anastomotic test technique in preventing anastomotic leakage after surgery of gastric cancer

作　　者：李博闻 曲建军[2] 朱光旭 Li Bowen;Qu Jianjun;Zhu Guangxu(School of Clinical Medicine,Shandong Second Medical University,Weifang 261000,China;Department of Gastrointestinal Surgery,Weifang People's Hospital,Weifang 261000,China)

机构地区：[1]山东第二医科大学临床医学院,潍坊261000 [2]潍坊市人民医院胃肠外科,潍坊261000

出　　处：《中国医学装备》2024年第12期185-190,共6页China Medical Equipment

基　　金：山东省医药卫生科技发展计划项目(202302171106)。

摘　　要：胃癌是胃肠道常见肿瘤之一,其治疗方法以手术治疗为主。吻合口漏是胃恶性肿瘤术后最严重的并发症之一,一旦发生会严重影响患者预后,甚至导致死亡。目前临床上针对吻合口漏的研究多聚焦术后“早诊断,早治疗”,缺乏有效的预防手段。术中吻合口测试(IOAT)技术是一种术中吻合口检测方法,多通过充气试验(ALT)、亚甲蓝渗漏试验(MBLT)、吲哚菁绿(ICG)标记荧光检测和胃镜等方法评估术中吻合口的完整性及血流灌注情况,在术中及时发现并处理吻合口的缺陷,降低术后吻合口漏发生率,能够降低患者术后病死率、改善术后生活质量、缩短住院时间并减轻患者经济负担;但有临床研究亦显示,IOAT不能预防术后吻合口漏的发生,可能导致吻合口组织坏死,其临床争论较大。为此,综述胃癌根治术IOAT技术的相关进展,以及IOAT与术后吻合口漏的发生率之间的关系,为预防胃癌术后吻合口漏提供临床参考。Gastric cancer is one of the most common gastrointestinal tumors,and at present,surgical treatment is the primary treatment.Anastomotic leakage is one of the most serious postoperative complications of gastric malignant tumor,once it occurs,it can severely impact patient prognosis and may even lead to death.At present,the clinical researches of anastomotic leakage focus on"early diagnosis,early treatment"after multi-focus operation,but it is lack in effective prevention measures.Intraoperative anastomotic testing(IOAT)is an intraoperative anastomotic testing method that primarily assesses the integrity and blood perfusion of the intraoperative anastomosis through air leak test(ALT),methylene blue leakage test(MBLT),indocyanine green(ICG)fluorescence image,gastroscopy,and other techniques,which can timely identify and treat anastomotic defects during surgery,and reduce the incidence of postoperatively anastomotic leakage,and decrease postoperative mortality,and enhance postoperative quality of life,and shorten hospital stays,and reduce the economic burden on patients.However,a few clinical studies have shown that IOAT cannot prevent postoperative anastomotic leakage and might lead to necrosis of anastomotic tissue.To review the progress of IOAT technique in radical gastrectomy for gastric cancer,and to summarize the relationship between IOAT and the incidence of postoperative anastomotic leakage,will provide a clinical reference for the prevention of anastomotic leakage after surgery for gastric cancer.

关 键 词：术中吻合口测试(IOAT) 胃癌 充气试验(ALT) 亚甲蓝渗漏实验(MBLT) 吲哚菁绿(ICG) 胃镜 吻合口漏 

分 类 号：R735.2[医药卫生—肿瘤]