引用文本：陈浩, 黄俊豪, 张博威, 等. 腹腔镜近端胃切除食管-管状胃吻合术技术要点[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(1): 170-175.

作者：陈浩，黄俊豪，张博威，杨祖立

单位：中山大学附属第六医院普通外科（胃外科二区），广东省结直肠盆底疾病研究重点实验室，广州市黄埔区中六生物医学创新研究院，广东 广州 510655

Authors：Chen Hao, Huang Junhao, Zhang Bowei, Yang Zuli

Unit：Department of Gastric Surgery Section 2, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Biomedical Innovation Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong, China

摘要：

腹腔镜近端胃切除联合管状胃重建是治疗cT_1~2期胃上部癌及食管胃结合部腺癌的标准术式之一。然而，该术式虽能保留胃功能，但术后反流性食管炎仍是其面临的主要难题。尽管传统管状胃重建在一定程度上减少了反流，但单纯的侧侧吻合仍存在抗反流机制不完善、吻合口狭窄等风险。笔者团队在前期实践的基础上，针对上述难点开展了“食管-管状胃overlap吻合+toupet样折叠”新技术。该术式强调制作宽3.5 cm、长20~22 cm的标准化管状胃以确保血供与张力适宜；在完成食管与管状胃侧侧吻合及关闭共同开口后，利用倒刺线将食管前壁与管状胃两侧浆肌层进行180°折叠缝合（缝合长度约5 cm），构建类似双肌瓣的抗反流屏障。笔者团队前期开展的29例手术资料显示，该改良术式安全可行，术后吻合口漏发生率3.4%（1/29），术后反流症状及内镜下反流性食管炎（A~B级）发生率均为6.9%（2/29），无吻合口狭窄发生。该术式通过规范化的食管-管状胃overlap吻合与toupet样折叠，有效解决了近端胃切除术后的反流痛点。

关键词：近端胃切除术；食管胃吻合；管状胃；胃底折叠术；食管胃结合部腺癌

Abstract：

Laparoscopic proximal gastrectomy (LPG) combined with gastric tube reconstruction is one of the standard procedures for the treatment of cT_1-2 upper gastric cancer and adenocarcinoma of esophagogastric junction (AEG). However, while preserving gastric function, postoperative reflux esophagitis remains a major challenge associated with this procedure. Although traditional gastric tube reconstruction reduces reflux to some extent, simple side-to-side anastomosis still carries risks such as imperfect anti-reflux mechanisms and anastomotic stenosis. To address these difficulties, the authors' team has developed a novel technique: esophagogastric overlap anastomosis combined with toupet-like fundoplication. This technique emphasizes the creation of a standardized gastric tube (3.5 cm in width and 20-22 cm in length) to ensure optimal blood supply and tension. After completing the side-to-side anastomosis between the esophagus and the gastric tube and closing the common entry hole, a barbed suture is used to perform a 180° plication of the anterior esophageal wall with the bilateral seromuscular layers of the gastric tube (suture length approximately 5 cm), constructing a double-flap-like anti-reflux barrier. Based on data from 29 cases performed by the authors' team, this modified procedure is safe and feasible. The incidence of anastomotic leakage was 3.4% (1/29). Both postoperative reflux symptoms and the incidence of endoscopic reflux esophagitis (Los Angeles grade A-B) were 6.9% (2/29), with no cases of anastomotic stenosis observed. In conclusion, through standardized esophagogastric overlap anastomosis and toupet-like fundoplication, this technique effectively addresses the critical issue of reflux following proximal gastrectomy.

Key words：Proximal gastrectomy; Esophagogastric anastomosis; Gastric tube; Fundoplication; Adenocarcinoma of esophagogastric junction

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