目的

对比不同食管空肠重建方法在胃癌患者全腹腔镜全胃切除术（TLTG）术食管空肠吻合术中的应用效果。

方法

回顾性分析2021年6月至2024年6月150例全腹腔镜全胃切除术患者的临床资料，依据食管空肠重建方法不同分为反穿刺组（n=75例）与Overlap组（n=75例），其中反穿刺组予以反穿刺法进行食管空肠重建，Overlap组予以Overlap法进行食管空肠重建，采用倾向性匹配评分法排除性别、年龄等基线资料混杂因素。比较两组患者手术情况（总手术时间、术中出血量、吻合时间、肿瘤上缘至食管切线距离、住院时间、住院费用）和术后恢复情况（术后首次下床活动时间、术后首次肛门排气时间、术后住院时间、术后进食流质饮食时间），以及术后并发症发生情况。

结果

两组患者总手术时间、术中出血量、肿瘤上缘至食管切线距离及住院时间比较无显著差异（P＞0.05），但反穿刺组吻合时间、住院费用显著低于Overlap组（P＜0.05）；两组患者术后恢复情况及并发症发生率比较均无显著差异（P＞0.05）。

结论

反穿刺法与Overlap法在胃癌患者TLTG术食管空肠吻合术中均安全可靠，但反穿刺法术式吻合时间更短，患者住院费用更低，可依据患者情况酌情选择合适术式。

Objective

To compare the application effects of different esophagojejunal reconstruction methods in esophagojejunostomy during transhiatal laparoscopic total gastrectomy （TLTG） for gastric cancer patients.

Methods

The clinical data of 150 patients who underwent transhiatal laparoscopic total gastrectomy from June 2021 to June 2024 were retrospectively analyzed.According to different esophagojejunal reconstruction methods，they were divided into the reverse puncture group （n=75 cases） and the Overlap group （n=75 cases）.The reverse puncture group underwent esophagojejunal reconstruction using the reverse puncture method，and the Overlap group underwent esophagojejunal reconstruction using the Overlap method.The propensity score matching method was used to exclude confounding factors such as gender and age in the baseline data.The surgical situations of the two groups of patients （total operation time，intraoperative blood loss，anastomosis time，the distance from the upper margin of the tumor to the esophageal tangent line，length of hospital stay，hospitalization cost） and postoperative recovery situations （the time of the first out-of-bed activity after surgery，the time of the first anal exhaust after surgery，the length of postoperative hospital stay，the time of taking liquid diet after surgery），as well as the occurrence of postoperative complications were compared.

Results

There were no significant differences in the total operation time，intraoperative blood loss，the distance from the upper margin of the tumor to the esophageal tangent line，and the length of hospital stay between the two groups of patients （P＞0.05）.However，the anastomosis time and hospitalization cost in the reverse puncture group were significantly lower than those in the Overlap group （P＜0.05）.There were no significant differences in the postoperative recovery situations and the incidence of complications between the two groups of patients（P＞0.05）.

Conclusion

Both the reverse puncture method and the Overlap method are safe and reliable in esophagojejunostomy during TLTG for gastric cancer patients.However，the anastomosis time of the reverse puncture method is shorter，and the hospitalization cost for patients is lower.The appropriate surgical method can be selected according to the patient's condition.