研究改良内翻手工缝合的Overlap吻合法在腹腔镜全胃切除术（LTG）中的效果。

前瞻性选取2020年1月至2022年3月行LTG的178例胃癌患者为研究对象，按随机数字表法将患者分为改良组（行改良内翻手工缝合的Overlap吻合法）和传统组（行传统Overlap吻合法），每组患者各89例。采用SPSS 22.0软件进行统计学分析，符合正态分布的计量资料以（±s）表示，两组间比较行独立样本t检验，组内比较行配对样本t检验；计数资料以[例（%）]表示，行χ²检验；Kaplan-Meier绘制生存曲线评估两组患者术后3年生存情况，采用Log-Rank检验。P<0.05表示差异有统计学意义。

两组患者均顺利完成LTG，无中转开腹及围手术期死亡病例。改良组患者手术时间及吻合时间较传统组显著降低，差异有统计学意义（P<0.05）；术后两组患者D-乳酸（D-LAC）、内毒素（ET）和二胺氧化酶（DAO）水平相较于术前均有显著升高，且改良组低于传统组，同时改良组患者肠绒毛高度、隐窝深度术后下降幅度小于传统组，差异均具有统计学意义（P<0.05）；改良组术后并发症的总发生率显著低于传统组（4.5% vs. 15.2%），差异有统计学意义（P<0.05）；改良组患者总生存率为61.8%，传统组总生存率为51.7%，两组总生存率比较（Log-Rank χ²=6.052，P=0.014），差异具有统计学意义（P<0.05）。

在LTG中，改良内翻手工缝合的Overlap吻合法展现出显著优势。该吻合法不仅降低吻合操作的难度，使手术流程得以简化，大幅缩短手术时间；同时对肠黏膜屏障功能的损伤小，有效降低术后并发症发生率。综合来看，改良内翻手工缝合Overlap吻合法是LTG中一种较为理想的吻合方式，具有临床应用价值。

To investigate the efficacy of the modified inverted hand-sutured Overlap anastomosis in laparoscopic total gastrectomy (LTG).

A prospective selection was made of 178 gastric cancer patients who underwent LTG at the Affiliated Hospital of Tangshan Vocational and Technical College from January 2020 to March 2022. The patients were divided into the modified group (undergoing modified inverted hand-sutured Overlap anastomosis) and the traditional group (undergoing traditional Overlap anastomosis) using a random number table method, with 89 patients in each group. Statistical analysis was performed using SPSS 22.0 software. Measurement data conforming to normal distribution, were expressed as (±s). Independent sample t test was used for comparison between the two groups, and paired sample t test was used for intragroup comparison. Count data were expressed as [cases (%)] and analyzed using the χ² test. Kaplan-Meier survival curves were plotted to evaluate the 3-year postoperative survival of patients in both groups, and the Log-Rank test was used to compare survival differences between groups. P<0.05 was considered statistically significant.

All patients in both groups successfully completed LTG, with no conversion to open surgery or perioperative deaths. The operation time and anastomosis time in the modified group were significantly shorter than those in the traditional group, with statistically significant differences (P<0.05). After surgery, the levels of D-lactate (D-LAC), endotoxin (ET), and diamine oxidase (DAO) in both groups were significantly higher than those before surgery, and the levels in the modified group were lower than those in the traditional group. Meanwhile, the postoperative decreases in intestinal villus height and crypt depth in the modified group were smaller than those in the traditional group, with statistically significant differences (P<0.05). The total incidence of postoperative complications in the modified group was significantly lower than that in the traditional group (4.5% vs. 15.2%), with a statistically significant difference (P<0.05). The overall survival rate was 61.8% in the modified group and 51.7% in the traditional group. The comparison of overall survival rates between the two groups (Log-Rank χ²=6.052, P=0.014) showed a statistically significant difference (P<0.05).

The modified inverted hand-sutured Overlap anastomosis shows significant advantages in LTG. This anastomotic method not only reduces the difficulty of anastomotic operation, simplifies the surgical process, and significantly shortens the operation time but also causes less damage to the intestinal mucosal barrier function and effectively reduces the incidence of postoperative complications. Overall, the modified inverted hand-sutured Overlap anastomosis is an ideal anastomotic method in LTG with clinical application value.