引用文本：陈育洪, 陈树林, 陈俊勇, 等. 腹腔镜胃癌手术中胃周血管变异及损伤处理策略[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(3):319-326.

作者：陈育洪1，陈树林2，陈俊勇1，雷德桥1，黄雪1，程黎阳1，谢正勇1

单位：1.中国人民解放军南部战区总医院普通外科，广东 广州 510010；2.中国人民解放军南部战区总医院放射科，广东 广州 510010

Authors：Chen Yuhong1, Chen Shulin2, Chen Junyong1, Lei Deqiao1, Huang Xue1, Cheng Liyang1, Xie Zhengyong1

Unit：1. Department of General Surgery, the General Hospital of Southern Theater Command, PLA, Guangzhou 510010, Guangdong, China；2. Radiology Department, the General Hospital of Southern Theater Command, PLA, Guangzhou 510010, Guangdong, China

摘要：

腹腔镜胃癌手术是胃外科的主流技术方案，具有高级别循证医学证据，而术中出血是最常见的并发症，与胃周血管解剖复杂及变异、肿瘤分期较晚、术前新辅助治疗的临床实施、手术团队技术能力等因素有关。术前，腹部增强计算机断层扫描（computed tomography, CT）联合CT血管造影（computed tomography angiography, CTA）在精确评估肿瘤分期的同时也能发现胃周血管解剖变异，因此，影像学解读是胃肠外科医生的必备技能，有助于识别所有血管变异并进行最优的术前规划，以减少并发症发生。术中，需强调规范化及程序化手术操作，以层面优先、血管导向为原则，提倡系膜区域化切除。此外，术者也应注重基础技能的培训和团队配合能力，熟练掌握各种止血方法并融会贯通。笔者综合文献报道并总结腹腔镜胃癌手术的操作经验，对术中胃周血管变异及损伤出血进行深入探讨，旨在提出针对性的预防和处理策略。

关键词：胃癌；胃周血管变异；出血；并发症；腹腔镜

Abstract：

Laparoscopic gastric cancer surgery is the mainstream technological approach in gastric surgery, supported by high-level evidence-based medicine. Intraoperative bleeding is the most common complication, which is related to factors such as the complex and variable anatomy of the perigastric vessels, advanced tumor staging, the clinical implementation of preoperative neoadjuvant treatment, and the technical capabilities of the surgical team. Preoperative abdominal enhanced computed tomography (CT) combined with computed tomography angiography (CTA) can accurately assess the tumor staging and simultaneously detect anatomical variations of the perigastric vessels. Interpretation of imaging is a necessary skill for gastrointestinal surgeons to identify all vascular variations, make optimal preoperative planning and reduce complications. Intraoperatively, emphasis is placed on standardized and proceduralized surgical paths, with the principle of layer prioritization and vessel guidance, advocating for regionalized resection of the mesentery. Besides, surgeons should pay attention to the training of basic skills and team coordination abilities, proficiently mastering various hemostatic methods and integrating them. The author synthesizes literature reports and summarizes the operational experience of laparoscopic gastric cancer surgery, conducting an in-depth discussion on the intraoperative perigastric vascular variations and injury bleeding, with the aim of developing targeted prevention and management strategies.

Key words：Gastric cancer; Variations of the perigastric vessels; Bleeding; Complication; Laparoscopic

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