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中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04): 253 -256. doi: 10.3877/cma.j.issn.1674-6899.2020.04.014

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综述 上一篇    

腹腔镜胃癌根治术后胰瘘围手术期预防策略
戴敏 1 , ( ), 朱海燕 2, 杨红生 1, 陆爱国 3   
  1. 1. 226600 海安,南通大学附属海安医院普外科
    2. 226600 海安,南通大学附属海安医院肿瘤科
    3. 200025 上海交通大学医学院附属瑞金医院胃肠外科
  • 收稿日期:2020-03-10 出版日期:2020-08-30
  • 通信作者: 戴敏
  • 基金资助:
    南通市市级科技计划指导性项目(MSZ18046)

Perioperative prophylactic strategies for pancreatic fistula after laparoscopic radical gastrectomy

Min Dai 1 , ( ), Haiyan Zhu 2, Hongsheng Yang 1, Aiguo Lu 3   

  1. 1. Department of Generalsurgery & Oncology Affiliated Haian Hospital to Nantong University, Haian 226600, China
    3. Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
  • Received:2020-03-10 Published:2020-08-30
  • Corresponding author: Min Dai
  • About author:
    Corresponding author: Dai Min, Email:

近年来腹腔镜胃癌根治术逐渐成为非晚期胃癌的主要手术方式,随之而来的并发症逐渐被认识。术后胰瘘作为严重的并发症,其发生率达5.3%~11.8%,高于开腹手术。这可能与腹腔镜操作的局限性及术中胰腺钝性损伤密切相关。术前腹部CT中P-A长度和UP-CA角度、体质量指数、术后3 d的C-反应蛋白水平与术后胰瘘发生率呈正相关。一种带有温度感控功能的超声刀及胰液渗出可视化系统有助于预防术后胰瘘,然而机器人手术和术前使用生长抑素不能降低术后胰瘘发生率。在胰腺上淋巴结清扫时需要进行方法改进,如"左侧入路""胰腺中间入路"等,"T"形纱布或组织悬吊装置可减少对胰腺的损伤,胰腺创面喷洒"生物胶"可减少胰液渗出。术后需要保持引流管通畅,若出现胰瘘,采用双套管冲洗+生长抑素持续微泵进行处理。笔者主要探讨腹腔镜胃癌根治术的术后胰瘘原因及围手术期相关预防策略,望能给术后胰瘘的诊治提供一些线索。

In recent years, laparoscopic radical gastrectomy has gradually become the main surgical method for non-advanced gastric cancer, and its complications are gradually recognized. Postoperative pancreatic fistula (POPF), as a serious complication, has an incidence of 5.3%- 11.8%, which is higher than that of open surgery.This may be closely related to the limitations of laparoscopic operation and blunt pancreatic injury during operation. Preoperative abdominal CT P-A length, UP-CA angle, BMI, and C-reactive protein levels on the third day after operation were positively correlated with the incidence of POPF. An ultrasound knife with temperature sensing function and visualization system of pancreatic exudation can help prevent POPF. However, robotic surgery and the use of somatostatin before surgery can not reduce the incidence of POPF.Methods should be improved when dissecting supra-pancreatic lymph nodes, such as "left approach" or "middle approach of pancreas" , "T-gauze" or tissue suspension device can reduce pancreatic injury, and "biological glue" spraying on pancreatic wounds can reduce pancreatic fluid exudation. After operation, the drainage tube was maintained unobstructed. In case of pancreatic fistula, double cannula irrigation and somatostatin continuous micropump were used. This article mainly discusses the causes of POPF in laparoscopic radical gastrectomy and perioperative prevention strategies, hoping to provide some clues for the diagnosis and treatment of POPF.

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