目的

研究腹腔镜近端胃切除不同消化道重建围手术期安全性及抗反流效果。

方法

回顾性分析2022年12月至2023年12月61例食管胃结合部腺癌手术患者病例资料。根据消化道重建方式不同分为观察组（n=31例）和对照组（n=30例），观察组消化道重建行改良单肌瓣吻合，对照组消化道重建行间置空肠吻合。采用统计学软件SPSS 22.0分析数据。所有数据均进行正态性检验。围手术期指标、食管动态PH监测指标等计量资料用（±s）表示，行独立样本t检验；术后并发症计数资料用［例（%）］表示，用χ²检验或Fisher精确概率法。P＜0.05表示差异有统计学意义。

结果

61例患者顺利完成完全近端胃癌切除术，无中转开腹。观察组消化道重建时间少于对照组（P＜0.05）；术后随访观察组PH＜4反流次数、PH＜4时间百分比、最长反流时间、反流持续时间＞5 min次数、Biox-Ochoa评分均低于对照组，差异具有统计学意义（P＜0.05）；观察组较对照组并发症发生率差异无统计学意义（3.2% vs.20.0%，P＞0.05）。

结论

在近端胃切除术中行改良单肌瓣吻合与间置空肠吻合，总体上安全可行，但改良单肌瓣吻合操作简单，抗反流效果确切，值得临床进一步推广运用。

Objective

To study the perioperative safety and anti-reflux effect of different digestive tract reconstructions after laparoscopic proximal gastrectomy.

Methods

The case data of 61 patients who underwent surgery for adenocarcinoma of the esophagogastric junction from December 2022 to December 2023 were retrospectively analyzed.According to different digestive tract reconstruction methods，they were divided into the observation group （n=31 cases） and the control group （n=30 cases）.The observation group underwent modified single muscular flap anastomosis for digestive tract reconstruction，and the control group underwent interposition jejunal anastomosis for digestive tract reconstruction.The statistical software SPSS 22.0 was used for statistical analysis of the data.All data were subjected to a normality test.Measurement data such as perioperative indexes and dynamic esophageal pH monitoring indexes were expressed as （±s），and an independent samples t test was performed.Counting data of postoperative complications were expressed as［cases （%）］，and the chi-square test or Fisher’s exact probability method was used.A P value less than 0.05 indicated a statistically significant difference.

Results

All 61 patients successfully completed total proximal gastrectomy without conversion to laparotomy.The time for digestive tract reconstruction in the observation group was less than that in the control group （P＜0.05）.The statistical results of postoperative follow-up showed that the number of refluxes with pH ＜ 4，the percentage of time with pH ＜ 4，the longest reflux time，the number of times with reflux duration ＞ 5 minutes，and the Biox-Ochoa score in the observation group were all lower than those in the control group，and the differences were statistically significant （P＜0.05）.There was no statistically significant difference in the incidence of complications between the observation group and the control group （3.2%vs. 20.0%，P＞0.05）.

Conclusion

Both modified single muscular flap anastomosis and interposition jejunal anastomosis in proximal gastrectomy are generally safe and feasible.However，the modified single muscular flap anastomosis is simple to operate and has a definite anti-reflux effect，which is worthy of further clinical promotion and application.