研究双镜联合功能保留胃切除术（FPG）对早期近端胃癌的治疗效果。

采用回顾性队列研究方法，分析2021年1月至2023年10月120例近端早期胃癌（EGC）患者的临床资料。根据手术方式不同，将患者分为观察组（n=68）和对照组（n=52）。观察组患者行内镜黏膜下剥离术（ESD）+腹腔镜下淋巴结清扫术（LLND）；对照组患者行腹腔镜近端胃切除术（LPG）。采用SPSS 24.0软件分析数据。符合正态分布的围手术期指标等计量资料以（±s）表示，行独立样本t检验；术后并发症发生率等计数资料用[例（%）]表示，比较采用χ²检验；TNM分期等级资料用例数表示，比较采用秩和检验；Kaplan-Meier法绘制生存曲线，采用Log-Rank检验。P<0.05为差异有统计学意义。

两组患者淋巴结清扫总数目对比，差异无统计学意义（P>0.05）；与对照组相比，观察组患者手术时间更长、术中失血量更少、疼痛程度更低、胃管留置时间、禁食时间以及住院时间更短（P<0.05）；对照组术后总并发症发生率28.9%高于观察组2.9%，Clavien-Dindo并发症分级，观察组显著轻于对照组（观察组：Ⅰ级1例、Ⅱ级1例、Ⅲ级0例；对照组：Ⅰ级8例、Ⅱ级5例、Ⅲ级2例）（P<0.05）；两组患者术前GLQI与PG-SGA评分对比，差异无统计学意义（P>0.05）；术后6、12个月，与对照组相比，观察组患者GLQI评分显著升高，PG-SGA评分显著下降（P<0.05）；对照组与观察组患者无病生存率对比，差异无统计学意义（Log-Rank χ²=0.367，P>0.05）。

相比于LPG术，LLND双镜胃癌根治术在近端EGC患者的围手术期指标、生存质量及术后营养改善方面表现出更为显著的优势。LLND手术有助于减少术中出血、缩短术后恢复时间，并能显著提高患者的术后生活质量。

To study the therapeutic effect of dual-endoscope combined function-preserving gastrectomy (FPG) for early proximal gastric cancer.

A retrospective cohort study was conducted to analyze the clinical data of 120 patients with early proximal gastric cancer (EGC) from January 2021 to October 2023. According to different surgical methods, the patients were divided into the observation group (n=68) and the control group (n=52). Patients in the observation group underwent endoscopic submucosal dissection (ESD) combined with laparoscopic lymph node dissection (LLND); patients in the control group underwent laparoscopic proximal gastrectomy (LPG). Data were analyzed using SPSS 24.0 software. Perioperative indicators and other measurement data with normal distribution were expressed as (±s) and analyzed by independent samples t test; counting data such as the incidence of postoperative complications were expressed as [cases (%)] and compared by χ² test; TNM staging data were expressed as case numbers and compared by Rank Sum test; Kaplan-Meier method was used to draw curves, and Log-Rank test was used for survival analysis. P<0.05 was considered statistically significant.

There was no statistically significant difference in the total number of dissected lymph nodes between the two groups (P>0.05). Compared with the control group, the observation group had longer operation time, less intraoperative blood loss, lower pain level, shorter gastric tube indwelling time, fasting time, and hospital stay (P<0.05). The total incidence of postoperative complications in the control group was 28.9%, which was higher than 2.9% in the observation group. In terms of Clavien-Dindo complication classification, the observation group was significantly milder than the control group (observation group: 1 case of grade Ⅰ, 1 case of grade Ⅱ, 0 cases of grade Ⅲ; control group: 8 cases of grade Ⅰ, 5 cases of grade Ⅱ, 2 cases of grade Ⅲ) (P<0.05). There were no statistically significant differences in preoperative Gastrointestinal Quality of Life Index (GLQI) and Patient-Generated Subjective Global Assessment (PG-SGA) scores between the two groups (P>0.05). At 6 and 12 months after surgery, compared with the control group, the observation group had significantly higher GLQI scores and significantly lower PG-SGA scores (P<0.05). There was no statistically significant difference in disease-free survival rate between the control group and the observation group (Log-Rank χ²=0.367, P>0.05).

Compared with LPG, dual-endoscope radical gastrectomy with LLND shows more significant advantages in perioperative indicators, quality of life, and postoperative nutritional improvement in patients with proximal EGC. LLND surgery helps reduce intraoperative bleeding, shorten postoperative recovery time, and significantly improve patients’ postoperative quality of life.