胃癌根治术后十二指肠残端漏防治

发布时间：2018-04-18 13:52

  本文选题：十二指肠残端漏 + 术前化疗　； 参考：《中国实用外科杂志》2017年04期

【摘要】：胃癌手术后发生十二指肠残端漏主要与其解剖特点以及胃癌的浸润转移程度等有关。十二指肠壁薄、位置固定,血供相对较差,内容物量大并具有腐蚀性,周围汇集着消化系统各种重要解剖结构,仅球部有少许游离度,可供闭合操作的长度有限。十二指肠球部周围是胃下部癌转移发生率最高的部位,当胃下部癌浸润或转移严重时将影响十二指肠球部的游离、闭合等操作,勉强实施则易发生漏。临床症状与漏出现的早晚、内容物漏出量多少、能否有效引流等因素有关。治疗上,控制感染的关键在于有效的引流,合理的营养支持是促进愈合的手段。再手术的目的是放置确切的引流,建立持久的营养支持途径。如果非手术方法能够达到此目的则可不选择手术。术前化疗可使肿瘤缩小,为确切关闭十二指肠残端等操作争取一定的空间,有利于预防十二指肠残端漏的发生。动静脉结合的术前化疗可以使疗效提高到约75.0%。
[Abstract]:Duodenal stump leakage after operation is mainly related to the anatomic characteristics and the degree of invasion and metastasis of gastric cancer.The duodenal wall is thin, the position is fixed, the blood supply is relatively poor, the contents are large and corrosive, the digestive system is surrounded by various important anatomical structures, only the sphere has a little degree of dissociation, and the length of the closed operation is limited.The proximal gastric carcinoma has the highest incidence of metastasis around the duodenal bulb. When the invasion or metastasis of the lower gastric carcinoma is serious, the free and closed duodenal bulb will be affected, but leakage will occur easily in the forced implementation.Clinical symptoms are related to the occurrence of leakage in the morning and evening, how much content leakage, whether effective drainage and other factors.In treatment, the key to control infection lies in effective drainage, and rational nutritional support is the means to promote healing.The purpose of re-operation is to establish a lasting nutritional support pathway by placing proper drainage.If the non-surgical method can achieve this purpose, you may not choose surgery.Preoperative chemotherapy can make the tumor shrink, and gain some space for the operation of closing duodenal stump accurately, which is helpful to prevent duodenal stump leakage.Preoperative chemotherapy combined with arteriovenous therapy can improve the efficacy to about 75. 0%.
【作者单位】： 中国人民解放军南京总医院普通外科;
【分类号】：R735.2
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本文编号：1768637