摘要
胰瘘作为胃癌术后严重并发症,其预防关键在于术中避免损伤胰腺。腹腔镜手术因视野局限、器械操作限制及能量器械热传导,可能增加胰瘘发生风险。但近期临床研究结果表明,随着技术进步,腹腔镜手术可成为B级及以上胰瘘的保护因素,说明技术成熟可克服其局限性。解剖结构特点决定手术难度。通过术前CT识别胰头突阳性,可指导手术避免损伤胰腺;胰腺表面与肝总动脉根部距离(≥25 mm)、胰腺与主动脉垂直距离以及胰腺上缘至胃左动脉根部高度是腹腔镜手术后胰瘘的独立预测指标,反映解剖操作难度。浅表型胰腺脂肪变性使胰瘘风险升高,内脏脂肪厚度亦为其危险因素。优化腹腔镜技术、术前CT评估解剖特征并针对性调整操作层面,可有效降低风险。
As a severe complication following gastric cancer surgery,the key to preventing pancreatic fistula lies in avoiding intraoperative pancreatic injury.Laparoscopic surgery may increase the risk of pancreatic fistula due to its limited field of view,restricted instrument maneuverability,and heat conduction from energy devices.However,recent clinical studies indicate that with technological advancements,laparoscopic surgery can serve as a protective factor against grade B or higher pancreatic fistulas,demonstrating that technical maturity can overcome its limitations.Anatomical features determine surgical difficulty.A positive pancreatic head process(PPH)significantly increases fistula risk,which preoperative CT identification can guide surgeons to avoid pancreatic damage.Key predictive indicators for laparoscopic postoperative fistulas include distance between the pancreatic surface and the root of the common hepatic artery(≥25 mm),vertical distance between the pancreas and aorta,and height from the pancreatic upper border to the root of the left gastric artery.These metrics reflect anatomical complexity during dissection.Superficial pancreatic steatosis elevates fistula risk,while increased visceral fat thickness is also a contributing factor.Risk reduction can be achieved by optimizing laparoscopic techniques,preoperative CT assessment of anatomical features,and targeted adjustment of surgical planes,effectively mitigating pancreatic fistula occurrence after gastric cancer surgery.
作者
付占威
蔡正昊
马君俊
臧潞
FU Zhan-wei;CAI Zheng-hao;MA Jun-jun;ZANG Lu(Department of Gastrointestinal Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai Minimal Invasive Surgery Center,Shanghai 200025,China)
出处
《中国实用外科杂志》
北大核心
2025年第7期832-834,840,共4页
Chinese Journal of Practical Surgery
基金
上海交通大学“医工交叉”项目(No.YG2023QNB07)。
关键词
胃癌
胰瘘
腹腔镜手术
胰腺解剖
人工智能
gastric cancer
pancreatic fistula
laparoscopic surgery
pancreatic anatomy
artificial intelligence
作者简介
通信作者:臧潞,E-mail:zanglu@yeah.net。
