腹腔镜胃癌根治术后十二指肠残端漏预防的研究进展  

Advance on prevention of duodenal stump leakage after laparoscopic radical gastrectomy for gastric cancer

作　　者：李路遥 刘吉祥 唐宇凡 周柏全 文兵兵 贾佳佳 沙颖 余柯 范瑞芳 LI Luyao;LIU Jixiang;TANG Yufan;ZHOU Baiquan;WEN Bingbing;JIA Jiajia;SHA Ying;YU Ke;FAN Ruifang(The Second Clinical Medical College of Lanzhou University,Lanzhou 730030,P.R.China;Department of General Surgery,The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou 730050,P.R.China;Medicine Department of Northwest Minzu University,Lanzhou 730030,P.R.China;The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730030,P.R.China)

机构地区：[1]兰州大学第二临床医学院,兰州730030 [2]中国人民解放军联勤保障部队第940医院普通外科,兰州730050 [3]西北民族大学医学部,兰州730030 [4]甘肃中医药大学第一临床医学院,兰州730030

出　　处：《中国普外基础与临床杂志》2025年第2期252-257,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：军队后勤科研计划项目(项目编号:20BJZ23);甘肃省科技计划项目(项目编号:22JR5RA004);联勤保障部队第940医院基础和临床培育项目(项目编号:2021yxky045)。

摘　　要：目的了解腹腔镜胃癌根治术后十二指肠残端漏(duodenal stump leakage,DSL)预防的新近研究进展,为减少DSL的发生寻找新的突破点。方法检索近年来国内外有关腹腔镜胃癌根治术后DSL相关研究的文献并进行综述。结果目前文献报道比较一致公认的与腹腔镜胃癌根治术后DSL的风险因素包括患者自身相关因素及手术相关因素。患者自身相关因素有高龄、营养不良、合并基础疾病等;手术相关因素有手术器械、医师操作水平等。文献报道针对患者自身相关因素采取的措施主要有术前改善营养状况、控制基础疾病的严重程度;针对手术相关因素采用的预防措施主要有术中精细操作、提高吻合技巧、团队默契配合。关于术中常规行十二指肠残端加固的效果和方式尚存在争议。结论减少DSL的发生重点在于预防。对于具有高危因素的患者应给予重点关注,改善患者术前营养状态及制定个体化策略,术中精细操作,尽可能减少并发症的发生,促进患者术后快速恢复。Objective To recognize the recent research progress in the prevention of duodenal stump leakage(DSL)after laparoscopic radical gastrectomy(LRG)for gastric cancer,so as to find a new breakthrough for reducing the occurrence of DSL.Method A review was conducted by searching recent domestic and international literature on the prevention and management of DSL after LRG for gastric cancer.Results At present,the risk factors of DSL after LRG were generally recognized in the literature,including relevant patients’factors and surgery factors.The relevant factors of the patients themselves mainly were old age,malnutrition,and basic diseases;The factors relevant surgery mainly included surgical instruments,doctors’operation level,etc.According to the literature,the measures taken for relevant patients’factors mainly included preoperative improvement of nutritional status and control of the basic diseases;The preventive measures adopted for the relevant operation factors mainly included carefully intraoperative operation,improving of the anastomosis skills,and tacit cooperation of the team,which could reduce the occurrence of DSL.There was still controversy about the effect and method of routine duodenal stump reinforcement during operation.Conclusions The focus of reducing the occurrence of DSL is prevention.In clinical practice,patients with high-risk factors should receive special attention,with efforts to improve their condition,implement individualized decision-making,and perform meticulous intraoperative techniques to minimize complications,promote rapidly postoperative recovery,and maximize patients benefits.

关 键 词：胃癌 腹腔镜胃癌根治术 十二指肠残端漏 十二指肠残端加固 预防 

分 类 号：R735.2[医药卫生—肿瘤]