目的

研究腹腔镜全胃切除术中改良反穿刺与改良overlap两种食管空肠吻合法的应用效果。

方法

前瞻性研究2021年1月至2023年4月82例Siewert Ⅱ型或Ⅲ型食管胃结合部腺癌（AEG）患者，均接受腹腔镜下全胃切除术（TLTG），随机数字表法分为2组，各41例。Overlap吻合组应用改良食管空肠Overlap吻合，反穿刺吻合组行改良反穿刺法食管空肠吻合。计量资料（如吻合时间、生活质量评分等）以（）表示，组间行独立样本t检验。并发症发生率以%表示，组间行χ²检验。

结果

两组手术顺利，无中转开腹病例，均行R0切除。两组术中出血量、淋巴结清扫总数、排气、进食时间以及住院时间对比，差异无统计学意义（P﹥0.05）；反穿刺吻合组吻合时间、手术时间、食管切缘与肿瘤上缘距离均较Overlap吻合组更长（P﹤0.05）。两组并发症总发生率对比，差异无统计学意义（9.8%vs.14.6%，P﹥0.05）。术前、术后6个月、术后12个月，两组患者QLQ-C30与QLQ-STOR22评分对比，差异无统计学意义（P﹥0.05）。

结论

在TLTG治疗Siewert Ⅱ型或Ⅲ型AEG中，改良Overlap吻合法操作简便，有助于缩短手术时间；而改良反穿刺吻合法则能提供更高的食管上切缘，显著降低Siewert Ⅱ型AEG中因食管位置较高导致的上切缘阳性风险。

Objective

To investigate the application effects of two modified esophagojejunostomy methods，namely the modified reverse puncture and the modified overlap，in laparoscopic total gastrectomy.

Methods

A prospective study was conducted on 82 patients with Siewert type Ⅱ or Ⅲadenocarcinoma of the esophagogastric junction（AEG）from January 2021 to April 2023.All patients underwent laparoscopic total gastrectomy（TLTG）and were randomly divided into two groups（41 cases in each group）using the random number table method.The overlap anastomosis group received the modified esophagojejunal overlap anastomosis，while the reverse puncture anastomosis group underwent the modified reverse puncture esophagojejunostomy.Measurement data（such as anastomosis time and quality-of-life scores）were expressed as（），and an independent-samples t test was performed between groups.The incidence of complications was expressed as a percentage，and a chi-square test was performed between groups.

Results

The operations in both groups were successfully completed without any cases converted to open surgery，and all patients received RO resection.There were no statistically significant differences between the two groups in terms of intraoperative blood loss，total number of lymph node dissections，time to flatus，time to start eating，and length of hospital stay（P﹥0.05）.The anastomosis time，operation time，and the distance between the esophageal resection margin and the upper edge of the tumor were all longer in the reverse puncture anastomosis group than in the overlap anastomosis group（P﹤0.05）.There was no statistically significant difference in the total incidence of complications between the two groups（9.8%vs.14.6%，P﹥0.05）.There were no statistically significant differences in the QLQ-C30 and QLQ-STOR22 scores between the two groups before surgery，6 months after surgery，and 12 months after surgery（P﹥0.05）.

Conclusion

In the treatment of Siewert typeⅡ or Ⅲ AEG with TLTG，the modified overlap anastomosis method is easy to operate and helps to shorten the operation time.In contrast，the modified reverse puncture anastomosis method can provide a higher upper esophageal resection margin，significantly reducing the risk of positive upper resection margins caused by the high position of the esophagus in Siewert type Ⅱ AEG.