目的

探究腹腔镜近端胃癌切除术（LPG）联合改良食管胃吻合术重建His角对术后反流性食管炎（RE）的临床效果。

方法

前瞻性选取2021年1月至2023年9月108例行LPG的患者为研究对象，采用信封法分为传统组和改良组，每组患者各54例。两组均行LPG，消化道重建过程中传统组采用传统的食管胃吻合法，改良组采用改良食管胃吻合术重建His角法。应用SPSS 25.0软件行数据分析，围手术期各项指标及反流性疾病问卷（RDQ）总分等计量资料用（±s）表示，比较采用独立样本t检验；并发症发生率、Visick评分分级及RE严重程度分级等计数资料用［例（%）］表示，比较用χ²检验或秩和检验。以P＜0.05为差异有统计学意义。

结果

改良组和传统组患者手术时间、消化道重建时间、淋巴结清扫枚数、术中出血量、肠功能恢复时间及术后住院时间比较，差异均无统计学意义（P＞0.05）；改良组患者并发症总发生率显著低于传统组（22.2% vs. 40.7%，P＜0.05）；改良组患者术后Visick评分分级及RE严重程度分布情况均优于传统组，RDQ总分显著低于传统组，差异均有统计学意义（P＜0.05）。

结论

LPG联合改良食管胃吻合术重建His角是安全、可行的，不会增加围手术期相关风险，同时可有效降低术后并发症发生风险，且抗反流效果显著，是一种较为理想的术式。

Objective

To explore the clinical effect of laparoscopic proximal gastrectomy （LPG）combined with modified esophagogastrostomy to reconstruct His Angle on postoperative reflux esophagitis （RE）.

Methods

108 patients with LPG from January 2021 to September 2023 were prospectively selected as the study objects， and were divided into traditional group and improved group by envelope method， with 54 patients in each group.Both groups were treated with LPG.In the process of digestive tract reconstruction， traditional esophagogastric anastomosis was used in the traditional group， and modified esophagogastrostomy was used in the improved group to reconstruct His Angle.SPSS 25.0 was used for data analysis.Measurement data such as perioperative indicators and total score of RDQ were expressed with （x± s ）.Independent sample t test was used for comparison.The statistical data of complication rate， Visick score grade and RE severity grade were expressed by ［cases （%）］， and compared by χ² test or Rank Sum test.P＜0.05 was considered to be statistically significant.

Results

There were no significant differences in operation time， digestive tract reconstruction time， number of lymph nodes dissection， intraoperative blood loss， intestinal function recovery time and postoperative hospitalization time between the improved group and the traditional group （P＞0.05）.The overall incidence of complications in the improved group was significantly lower than that in the traditional group （22.2%vs. 40.7%， P＜0.05）.The Visick score and the distribution of RE severity in the improved group were better than those in the traditional group， and the total score of RDQ was significantly lower than that in the traditional group， with statistical significance （P＜0.05）.

Conclusion

LPG combined with modified esophagogastrostomy to reconstruct His Angle is safe and feasible， does not increase perioperative related risks， and can effectively reduce the risk of postoperative complications， and has significant anti-reflux effect， so it is a relatively ideal operation.