探索近端胃切除双通道吻合重建在食管胃结合部癌中的临床应用价值。

回顾性收集2018年12月至2023年6月于中山市人民医院行手术治疗的79例食管胃结合部癌患者临床资料，根据手术方式分为近端胃切除双通道吻合重建组（试验组，35例）及全胃切除Roux-en-Y吻合重建组（对照组，44例）。主要观察指标包括患者围手术期情况（手术时间、术中出血量、术后肛门排气时间及术后总住院时间）、术后短期并发症（术后吻合口漏、吻合口狭窄、肠梗阻、肺部感染及反流性食管炎）以及术后营养状况[术后第6个月的白蛋白、血红蛋白、预后营养指数（PNI）及第三腰椎层面骨骼肌指数]。

两组患者术前临床基线资料对比差异无统计学意义。相对于对照组，试验组的手术时间、术中出血量、术后总住院时间、术后肛门排气时间未见增加，两组差异均无统计学意义（t=-1.613、-0.761、-1.162，Z=-0.848，P=0.111、0.447、0.245、0.396）。在术后近期并发症方面，两组患者术后吻合口漏、吻合口狭窄、肠梗阻、肺部感染及反流性食管炎等并发症发生率对比，差异无统计学意义（χ²=1.143、0.533、0.152、0.055、0.022，P=0.285、0.465、0.697、0.814、0.883）。但在术后随访第6个月时，试验组的术后营养状况恢复更佳，两组白蛋白、血红蛋白水平和PNI第三腰椎层面骨骼肌指数相比，差异均有统计学意义（t=2.660、2.593、2.706、2.529，P=0.010、0.011、0.008、0.013）。

在治疗食管胃结合部癌方面，近端胃切除双通道吻合的安全性与全胃切除Roux-en-Y吻合相当，但近端胃切除双通道吻合重建患者的术后营养状况恢复更佳，具有一定的临床应用推广价值。

To explore the clinical application values of proximal gastrectomy with double-channel anastomosis reconstruction in esophagogastric junction carcinoma.

The clinical data of 79 patients with esophagogastric junction carcinoma who underwent surgical treatment in Zhongshan City People’s Hospital from December 2018 to June 2023 were retrospectively collected. According to the surgical approaches, the patients were divided into the proximal gastrectomy with double-channel anastomosis reconstruction group (trial group, 35 cases) and the total gastrectomy with Roux-en-Y anastomosis reconstruction group (control group, 44 cases). The main observation indicators included the perioperative conditions (operation time, intraoperative blood loss, time to postoperative anal exhaust, and total postoperative hospital stay), short-term postoperative complications (postoperative anastomotic leakage, anastomotic stricture, intestinal obstruction, pulmonary infection, and reflux esophagitis), and postoperative nutritional status including albumin, hemoglobin, prognostic nutritional index (PNI), and skeletal muscle mass index at the 6th month after surgery.

There were no statistically significant differences in the preoperative clinical baseline data between the two groups. Compared with the control group, there were no statistically significant differences in the operation time, intraoperative blood loss, total postoperative hospital stay, and time to postoperative anal exhaust in the trial group (t=-1.613, -0.761, -1.162, Z=-0.848, P=0.111, 0.447, 0.245, 0.396). In terms of short-term postoperative complications, there were no statistically significant differences in the incidences of postoperative anastomotic leakage, anastomotic stricture, intestinal obstruction, pulmonary infection, and reflux esophagitis between the two groups (χ²=1.143, 0.533, 0.152, 0.055, 0.022, P=0.285, 0.465, 0.697, 0.814, 0.883). However, at the 6th month of postoperative follow-up, the postoperative nutritional status of the trial group recovered better. There were statistically significant differences in albumin, hemoglobin, PNI, and skeletal muscle mass index between the two groups (t=2.660, 2.593, 2.706, 2.529, P=0.010, 0.011, 0.008, 0.013).

In the treatment of esophagogastric junction carcinoma, the safety of proximal gastrectomy with double-channel anastomosis is comparable to that of total gastrectomy with Roux-en-Y anastomosis. However, patients undergoing proximal gastrectomy with double-channel anastomosis reconstruction may have better recovery of postoperative nutritional status, which has certain values for clinical application and promotion.