腹腔镜胃癌根治术中出血性并发症的预防及处理

Prevention and treatment of hemorrhagic complications in the laparoscopic radical gastrectomy

术中出血是腹腔镜胃癌根治术中最常见的并发症,也是中转开腹最主要的原因。随着腹腔镜手术技术在全世界范围内的推广普及,如何高质量地完成手术、有效避免术中和(或)术后并发症的发生是全体外科医师追求的目标。腹腔镜胃癌根治术术中出血主要分为实质脏器损伤出血、胃周血管损伤出血、淋巴结出血和机械闭合线出血等方面。压迫、电凝、血管夹闭及血管缝合修补是处理术中出血最常见的方式,在临床工作中,通常需要综合使用上述方法止血。熟练掌握腹腔镜操作技巧、熟识胃周血管解剖及变异情况、提高团队配合度以降低并发症的发生是腹腔镜胃癌手术操作的关键。笔者综合文献报道,总结该团队从事腹腔镜胃癌手术的操作经验,对腹腔镜胃癌根治术中出血性并发症的预防及处理策略进行深入探讨。

Intraoperative hemorrhage is the most common complication of laparoscopic radical gastrectomy, which is also the main cause of conversion to open surgery. With the popularization of laparoscopic surgery technology worldwide, how to complete high-quality surgery and effectively avoid intraoperative or postoperative complications is the goal pursued by all surgeons. Intraoperative hemorrhage in the laparoscopic radical gastrectomy is mainly divided into parenchymal hemorrhage, perigastric vascular injury-induced hemorrhage, lymph node hemorrhage and anastomotic bleeding. Compression, electrocoagulation, vascular clipping and vascular suture repair are the most common treatments for intraoperative hemorrhage. It is necessary to use above methods in clinical work. Proficiency in laparoscopic operation skills, familiarity with perigastric vascular anatomy and variation, and improved teamwork to reduce complications are the key to laparoscopic surgery for gastric cancer. Combined with literature reports, the authors summarize experience in laparoscopic surgery for gastric cancer, discuss the prevention and treatment of hemorrhagic complications during laparoscopic radical gastrectomy.