微创外科时代胃手术并发症特点及防治

Prevention and treatment of surgery-related complications of gastrectomy in era of minimally invasive surgery

近20年来,微创已成为胃外科的发展方向。大量临床数据显示,与开放手术比较,腹腔镜胃手术不但具有美容效果,同时可减少术中失血、减轻腹腔粘连和术后疼痛、加快胃肠功能恢复以及缩短住院时间。腹腔镜胃手术中,术中出血是最常见的并发症,术后迟发性大出血是最危险的并发症,也是造成病人死亡的最主要原因;十二指肠残端漏也是不可忽视的手术并发症,应积极应对;胰瘘发生率虽然明显低于开放手术,但同样须认真对待。3D腹腔镜还原了真实的手术野且增加了放大倍数,故较2D腹腔镜具有更短的学习曲线,术中出血的发生率更低。机器人手术系统是外科手术的革命性成果,裸眼3D高倍图像以及灵活防手颤的机械臂有望进一步减少手术相关并发症发生,从而达到微创、精准的目的。

In recent 20 years minimally invasive surgery has become the main direction of gastric surgery. Laparoscopic gastrectomy not only results in better cosmetic outcomes, but also reduces intraoperative blood loss, adhesion in peritoneal cavity and postoperative pain, leading to faster recovery of peristalsis and shorter hospital stay. Intraoperative bleeding is the most common complication. Postoperative delayed massive heamorrhage is the fatal complication which may cause the death of the patients. Duodenal stump leakage is one of the complication which should not be ignored and should be treated aggressively. Although the incidence of pancreatic fistula is significantly lower than that of open surgery, it should be taken seriously. The three-dimension （3D） laparoscopic system can restore the amplifying real operative field. The learning curve of the beginners by 3D laparoscopy will be shortened and the probability of bleeding during the operation will be decreased when compared with 2D laparoseopy. Robotic surgical system is a revolutionary achievement of surgery. The naked eye amplifying 3D operative field and flexible mechanical arms help the operator to reduce the surgery-related complications and achieve the aim of minimally invasive and accurate operation.