本文選題：十二指腸殘端漏 + 術(shù)前化療�。� 參考：《中國實用外科雜志》2017年04期

【摘要】：胃癌手術(shù)后發(fā)生十二指腸殘端漏主要與其解剖特點以及胃癌的浸潤轉(zhuǎn)移程度等有關(guān)。十二指腸壁薄、位置固定,血供相對較差,內(nèi)容物量大并具有腐蝕性,周圍匯集著消化系統(tǒng)各種重要解剖結(jié)構(gòu),僅球部有少許游離度,可供閉合操作的長度有限。十二指腸球部周圍是胃下部癌轉(zhuǎn)移發(fā)生率最高的部位,當(dāng)胃下部癌浸潤或轉(zhuǎn)移嚴(yán)重時將影響十二指腸球部的游離、閉合等操作,勉強(qiáng)實施則易發(fā)生漏。臨床癥狀與漏出現(xiàn)的早晚、內(nèi)容物漏出量多少、能否有效引流等因素有關(guān)。治療上,控制感染的關(guān)鍵在于有效的引流,合理的營養(yǎng)支持是促進(jìn)愈合的手段。再手術(shù)的目的是放置確切的引流,建立持久的營養(yǎng)支持途徑。如果非手術(shù)方法能夠達(dá)到此目的則可不選擇手術(shù)。術(shù)前化療可使腫瘤縮小,為確切關(guān)閉十二指腸殘端等操作爭取一定的空間,有利于預(yù)防十二指腸殘端漏的發(fā)生。動靜脈結(jié)合的術(shù)前化療可以使療效提高到約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%.
【作者單位】： 中國人民解放軍南京總醫(yī)院普通外科;
【分類號】：R735.2
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本文編號：1768637