关键词: 胃癌, 胰瘘, 腹腔镜手术, 胰腺解剖, 人工智能

Abstract: As a severe complication following gastric cancer surgery, the key to preventing pancreatic fistula lies in avoiding intraoperative pancreatic injury. Laparoscopic surgery may increase the risk of pancreatic fistula due to its limited field of view, restricted instrument maneuverability, and heat conduction from energy devices. However, recent clinical studies indicate that with technological advancements, laparoscopic surgery can serve as a protective factor against grade B or higher pancreatic fistulas, demonstrating that technical maturity can overcome its limitations. Anatomical features determine surgical difficulty. A positive pancreatic head process (PPH) significantly increases fistula risk, which preoperative CT identification can guide surgeons to avoid pancreatic damage. Key predictive indicators for laparoscopic postoperative fistulas include distance between the pancreatic surface and the root of the common hepatic artery (≥25 mm), vertical distance between the pancreas and aorta, and height from the pancreatic upper border to the root of the left gastric artery. These metrics reflect anatomical complexity during dissection. Superficial pancreatic steatosis elevates fistula risk, while increased visceral fat thickness is also a contributing factor. Risk reduction can be achieved by optimizing laparoscopic techniques, preoperative CT assessment of anatomical features, and targeted adjustment of surgical planes, effectively mitigating pancreatic fistula occurrence after gastric cancer surgery.

Key words: gastric cancer, pancreatic fistula, laparoscopic surgery, pancreatic anatomy, artificial intelligence