关键词: 十二指肠残端漏, 术前化疗, 动静脉结合给药, 胃癌

Abstract:

Prevention and treatment of duodenal stump leakage after radical gastrectomy for gastric cancer        LI Guo-li，WANG Xu-lin，HE Qi. Department of General Surgery，Nanjing General Hospital of Nanjing Military Command of PLA，Nanjing 210002，China
Corresponding author: LI Guo-li，E-mail: drguoli@aliyun.com
Abstract    The occurrence of duodenal stump leakage after gastric cancer surgery is mainly related to its anatomical features, tumor invasion and metastasis. The duodenum wall is thin and fixed. It has poor blood supply，and massive corrosive fluid in it. Also，the duodenum is connected to a variety of important structures of the digestive system，and only the duodenal bulb is mobile，limiting the maneuverability of suture devices for duodenal stump closure. The duodenal bulb is the most common site of metastasis of lower part gastric cancer. When cancer spreads to the duodenal bulb，it will cause difficulty in the dissection and closure of the duodenal stump，leading to a higher risk of duodenal stump leakage. The clinical symptoms are related to the time of leakage occurring，the amount of leakage contents，the establishment of effective drainage，etc. For treatment，the key to the control of infection is effective drainage，and reasonable nutrition support is an essential mean to promote healing. The purpose of a salvage surgery is to place an exact drainage and establish a long-term nutritional supportive route. If the purpose can be achieved by non-operative procedure，the salvage surgery is not necessary. Preoperative chemotherapy inducing tumor shrinkage，would improve the chance to safely suture the duodenal stump，which is of great significance to prevent the duodenal stump leakage. Preoperative chemotherapy via intra-arterial and intravenous administration could higher the response rate to around 75%.

Key words: duodenal stump leakage, preoperative chemotherapy, intra-arterial and intravenous administration, gastric cancer