探讨λ型食管空肠吻合在全腹腔镜根治性全胃切除术中的安全性、可行性及近期疗效。

回顾性分析2021年01月至2021年07月连续入组行全腹腔镜下根治性全胃切除并采用λ型食管空肠吻合20例胃/胃食管结合部腺癌患者，且有完整的病例资料和随访。

男性12例，女性8例，年龄42~76（60.9±5.6）岁。胃食管结合部腺癌11例（其中Siewert Ⅱ型9例；Siewert Ⅲ型2例），胃体近端腺癌9例。所有患者均在全腹腔镜下顺利完成根治性全胃切除及D2淋巴结清扫并腔内采用λ型食管空肠吻合行消化道重建。手术总时间235~295（249.4±48.5）min，消化道重建时间（48.2±23.2）min，术中出血量（63.4±48.4）ml；恢复排气时间（3.1±2.2）d；首次饮水或进食时间（3.1±2.2）d、住院时间（7.3±4.4）d；出现术后并发症3例，分别为十二指肠残端漏合并腹腔感染1例、吻合口出血1例、术后炎性肠梗阻1例，均给予保守治疗痊愈。20例患者均有完整随访，全组患者营养指数（PNI）：术前为53.5±8.4，术后1周为47.3±5.6，术后6个月时为50.3±5.6，术后12个月时为52.4±4.2。Roux-en-Y滞留综合征发生率5.0%（1/20），胆汁反流性食管炎发生率5.0%（1/20），无食管空肠吻合口输入袢闭合端再通，无吻合口狭窄、梗阻、肿瘤复发。

λ型食管空肠吻合在全腹腔镜根治性全胃切除术消化道重建中安全、可行，此种消化道重建方式不仅保持肠道连续性，还简化了手术操作步骤，患者术后恢复快、近期疗效好。

To investigate the safety，feasibility and short-term efficacy of λ esophagojejunostomy in total laparoscopic radical gastrectomy.

A retrospective analysis was made of 20 patients with adenocarcinoma of the gastric/gastroesophageal junction who underwent radical total gastrectomy and λ esophagojejunostomy under total laparoscopy from January 2021 to July 2021. Complete case data and follow-up were available.

There were 12 males and 8 females，aged 42 to 76（60.9±5.6）years. There were 11 cases of adenocarcinoma of the gastroesophageal junction（9 cases of Siewert type Ⅱ；2 cases of Siewert type Ⅲ），9 cases of proximal gastric adenocarcinoma. All patients successfully completed radical gastrectomy and D2 lymph node dissection under total laparoscopy，and underwent gastrointestinal reconstruction with λ esophagojejunal anastomosis. The total operation time was 235-295（249.4±48.5）min，the reconstruction time of digestive tract was 48.2±23.2 min，and the intraoperative blood loss was 63.4±48.4 ml. Recovery exhaust time（3.1±2.2）d；First drinking or eating time（3.1±2.2）d，hospital stay（7.3±4.4）d；Postoperative complications occurred in 3 cases，including duodenal stump leakage combined with abdominal infection in 1 case，anastomotic hemorrhage in 1 case and postoperative inflammatory intestinal obstruction in 1 case，all of which were cured by conservative treatment. The nutritional index（PNI）of the 20 patients was 53.5±8.4 before surgery，47.3±5.6 1 week after surgery，50.3±5.6 6 months after surgery，and 52.4±4.2 12 months after surgery. The incidence of Roux-en-Y retention syndrome was 5.0%（1/20），the incidence of bile reflux esophagitis was 5.0%（1/20），there was no recanalization of the closed end of the input loop of the esophagojejunostomy，no anastomotic stenosis，obstruction，or anastomotic tumor recurrence.

λ esophagojejunal anastomosis is safe and feasible in total laparoscopic radical gastrectomy digestive tract reconstruction. This reconstruction method not only maintains intestinal continuity，but also simplifies the operation procedure，and the postoperative recovery is fast and the short-term effect is good.