下肢深静脉血栓形成（DVT）是胃肠外科手术患者围手术期常见且可预防的并发症，可进展为肺血栓栓塞症（PTE）并危及生命。胃肠外科患者疾病谱复杂，常合并恶性肿瘤、肠梗阻、腹腔感染、炎症性肠病、营养不良、术前肠道准备、围手术期禁食、术后活动受限及消化道或吻合口出血风险，导致血栓形成风险与出血风险长期并存。近年来，随着加速康复外科、腹腔镜及机器人手术、电子化风险评估系统、机器学习预测模型和新型抗凝药物的发展，胃肠外科围手术期静脉血栓栓塞症管理逐渐由经验性预防转向分层化、动态化和个体化管理。本文围绕胃肠外科围手术期DVT的流行病学特征、专科化发生机制、危险因素、风险评估工具、预防策略、诊断治疗衔接及质量管理进行综述，重点讨论Caprini评分“天花板效应”、直接口服抗凝药在胃肠道肿瘤术后应用安全性及延长预防适用人群等争议。本文认为，胃肠外科围手术期DVT管理不应依赖单一评分或固定抗凝路径，而应建立“基础评分-专科变量-出血风险-动态复评-出院随访”相结合的闭环管理模式，以期为临床规范化防治提供参考。

Deep vein thrombosis (DVT) of the lower extremities is a common yet preventable perioperative complication in patients undergoing gastrointestinal surgery, which may progress to life-threatening pulmonary embolism (PTE). Gastrointestinal surgical patients often present with complex disease profiles, frequently complicated by malignancy, intestinal obstruction, intra-abdominal infection, inflammatory bowel disease, malnutrition, preoperative bowel preparation, perioperative fasting, postoperative mobility limitations, and risks of gastrointestinal or anastomotic bleeding. These factors result in a prolonged coexistence of both thrombotic and bleeding risks. In recent years, advances in enhanced recovery after surgery, laparoscopic and robotic techniques, electronic risk assessment systems, machine learning prediction models, and novel anticoagulants have gradually shifted management of venous thromboembolism (VTE) in gastrointestinal surgery from empirical prevention toward stratified, dynamic, and individualized approaches. This review focuses on the epidemiological characteristics, specialized pathogenesis, risk factors, risk assessment tools, preventive strategies, diagnostic-treatment integration, and quality management of perioperative DVT in gastrointestinal surgery, with particular emphasis on controversies such as the "ceiling effect" of the Caprini score, the safety of direct oral anticoagulants following gastrointestinal cancer surgery, and the appropriate patient populations for extended prophylaxis. The authors argue that perioperative DVT management in gastrointestinal surgery should not rely solely on single scoring systems or fixed anticoagulation protocols, but instead adopt a closed-loop model integrating baseline scoring, specialty-specific variables, bleeding risk, dynamic reassessment, and post-discharge follow-up, aiming to provide guidance for standardized clinical prevention and treatment.