引用文本：王利明, 蔡旭浩, 温浩祥, 等. 食管残胃全腔镜下斜角吻合加单肌瓣成形术的技术要点及临床应用[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 509-515.

作者：王利明1，蔡旭浩1，温浩祥2，马浩越1，孙鹏1，陈瑛罡1

单位：1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科，广东 深圳　518116；2. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院肝胆外科，广东 深圳　518116

Authors：Wang Liming1, Cai Xuhao1, Wen Haoxiang2, Ma Haoyue1，Sun Peng1, Chen Yinggang1

Unit：1. Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong, China；2. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong, China

摘要：

目的 介绍食管残胃全腔镜下改良单肌瓣成形术——斜角吻合加单肌瓣成形术（oblique anastomosis plus single flap valvuloplasty, OSF）的技术要点及其在食管胃结合部癌手术中的应用情况。方法 2022年1月至2025年1月中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科对20例Siewert Ⅱ型食管胃结合部癌患者开展了OSF。主要步骤如下：①近端胃切除及淋巴结清扫；②制作残胃单肌瓣；③食管残胃吻合；④缝合单肌瓣。回顾性分析患者的基线资料、围手术期结局及术后随访结果。结果 行OSF的患者中，男性12例，女性8例，平均年龄（68.2±6.8）岁，体重指数为（21.88±6.20） kg/m²，肿瘤长径为（2.2±0.4） cm。20例患者均顺利完成OSF重建。中位手术时间255（225~428） min，中位重建时间112（76~140） min，中位失血量50（20~400） ml。术后病理分期为Ⅰ期的有12例，Ⅱ～Ⅲ期有8例。术后中位进食时间为4（4~6） d，术后中位住院时间为7（6~10） d。术后早期并发症包括3例肺炎、1例胆囊炎，均经保守治疗后好转。术后6周出现1例吻合口狭窄，内镜下扩张3次后恢复正常进食。术后1年复查时，20例患者均未出现B级及以上反流性食管炎，所有患者均不需服用抗反流药物。体重减轻＞10%为2例。结论 OSF是一种具有良好抗反流效果的、安全的食管残胃重建方法。

关键词：食管胃结合部癌；单肌瓣成形术；近端胃切除

Abstract：

Objective To introduce the technical key points of the totally laparoscopic modified single flap valvuloplasty for the esophago-remnant gastric—oblique anastomosis plus single flap valvuloplasty (OSF)—and its application in surgeries for esophagogastric junction (EGJ) cancer. Method From January 2022 to January 2025, 20 patients with Siewert type Ⅱ EGJ cancer undergoing laparoscopic proximal gastrectomy underwent reconstruction using the OSF technique in the Department of Gastrointestinal Surgery at Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The surgical steps were as follows: ①proximal gastrectomy and lymph node dissection; ②creation of a single flap of the remnant stomach; ③esophago-gastric anastomosis; ④suturing of the single flap. A retrospective analysis was conducted on the baseline characteristics, perioperative outcomes, and postoperative follow-up data of these 20 patients. Result Among the patients who underwent OSF reconstruction, 12 were males and 8 were females, with an average age of (68.2±6.8) years, an average body mass index of (21.88±6.20) kg/m², and an average tumor diameter of (2.2±0.4) cm. The median operation time was 255 (225-428) minutes, the median reconstruction time was 112 (76-140) minutes, and the median blood loss was 50 (20-400) ml. Pathological staging revealed stage Ⅰ in 12 patients and stage Ⅱ-Ⅲ in 8 patients. The median time to start oral intake was 4 (4-6) days, and the median postoperative hospital stay was 7 (6-10) days. Early postoperative complications included 3 cases of pneumonia and 1 case of cholecystitis, all improved with conservative management. 6 weeks after the operation, 1 case of anastomotic stenosis occurred. After 3 times of endoscopic dilation, the patient resumed normal eating. At the 1-year endoscopic follow-up, no patient exhibited reflux esophagitis of Grade B or higher, and none required anti-reflux medication. Weight loss exceeding 10% was observed in 2 patients. Conclusion The OSF technique is a safe and effective reconstruction method following proximal gastrectomy for EGJ cancer, demonstrating excellent anti-reflux efficacy.

Key words：Esophagogastric junction cancer; Single flap valvuloplasty; Proximal gastrectomy

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