中国实用外科杂志2025，Vol.45Issue(3)：309-315,7.DOI:10.19538/j.cjps.issn1005-2208.2025.03.14
胃癌术后发生十二指肠残端漏风险:一项前瞻性多中心观察性研究
The incidence of duodenal stump leakage after gastrectomy for gastric cancer:A prospective multicenter observational study
摘要
Abstract
Objective To explore the incidence,risk factors,and diagnostic value of postoperative drainage fluid analysis in detecting duodenal stump leakage(DSL)following gastric cancer surgery under current surgical conditions in China.Methods A prospective multicenter observational study was conducted,enrolling 1036 patients who underwent gastric cancer surgery at nine centers in China between February 2021 and December 2022.Postoperative drainage fluid amylase and direct bilirubin levels were monitored on days 1,3,5,and 7.The primary endpoint was the incidence of DSL,while secondary endpoints included Clavien-Dindo classification,complication rates,and dynamic changes in biochemical indicators of drainage fluid.Results The overall incidence of DSL was 0.97％(10/1036),with the majority of cases classified as Clavien-Dindo grade Ⅱ(50.0％)and Ⅲ a(30.0％).The proportion of patients with cardiovascular and cerebrovascular comorbidities was significantly higher in the DSL group compared to the non-DSL group(60.0％vs.23.7％,P=0.016).The incidence of DSL was significantly higher in the hand-sewn anastomosis group compared to the stapler closure group(33.3％vs.0.9％,P=0.029).The hospital stay for patients with DSL was significantly longer than for those without DSL(24.4 days vs.10.9 days,P＜0.001).Amylase and direct bilirubin levels in the drainage fluid showed a persistent increase in the DSL group(reaching 35250.2 U/L and 44.9 μmol/L on day 7 postoperatively,respectively),but the differences between groups were not statistically significant.All DSL cases were cured with fasting,gastrointestinal decompression,somatostatin,antibiotics,and adequate drainage,with no mortality.Conclusion The incidence of DSL after gastric cancer surgery has decreased to 0.97％,and stapler closure of the duodenal stump is a safe and feasible approach.Dynamic monitoring of amylase and direct bilirubin levels in postoperative drainage fluid may provide early diagnostic evidence,but larger sample studies are needed for validation.关键词
胃癌/十二指肠残端漏/前瞻性多中心研究/直线切割闭合器/Clavien-Dindo分级/引流液淀粉酶/直接胆红素/手工离断Key words
gastric cancer/duodenal stump leakage/prospective multicenter study/linear stapler/Clavien-Dindo classification/drainage fluid amylase/direct bilirubin/manual transection分类
医药卫生引用本文复制引用
苗儒林,李子禹,任双义,张涛,田艳涛,曲建军,潘源,王权,梁品,于文滨..胃癌术后发生十二指肠残端漏风险:一项前瞻性多中心观察性研究[J].中国实用外科杂志,2025,45(3):309-315,7.基金项目
首都卫生发展科研专项基金项目(首发2024-1-2152) Capital's Funds for Health Improvement and Research(CFH 2024-1-2152) （首发2024-1-2152）
