食管两步切开联合荷包线悬吊优化右开襟单肌瓣吻合在腹腔镜近端胃切除中的初步应用（附视频）

Preliminary application of right-sided overlap and single-flap valvuloplasty optimized by two-step esophageal incision combined with purse-string suspension in laparoscopic proximal gastrectomy (with video)

摘要:

背景与目的 右开襟单肌瓣吻合术（ROSF）是腹腔镜近端胃切除术后兼顾抗反流与功能保留的重要重建方式，但传统ROSF在食管切开、共同开口关闭及食管断端回缩控制等方面仍存在一定技术难点。本研究探讨食管两步切开联合食管断端荷包线悬吊技术优化ROSF吻合在腹腔镜近端胃切除术中的安全性与可行性。方法 回顾性分析2024年8月—2025年12月郑州大学附属肿瘤医院33例行腹腔镜近端胃切除术+改良ROSF重建患者的临床资料。改良技术包括食管两步切开、食管断端荷包线悬吊固定及分层食管切开等关键步骤。观察围手术期指标、术后并发症及近期随访结果。结果 33例患者均顺利完成手术，无中转开腹及围手术期死亡。食管两步切开可实现食管断端整齐切开并维持黏膜层与肌层良好对位；荷包线悬吊有效防止食管断端回缩，提高了吻合稳定性。ROSF重建平均操作时间为（37.9±9.7）min，术中出血量为（137.2±45.8）mL，术后首次排气时间为（2.1±0.5）d，首次进食流质时间为（5.9±0.3）d，术后住院时间为（10.0±3.2）d。围手术期并发症发生率为12.1%（4/33），均为Clavien-Dindo并发症分级Ⅰ~Ⅱ级并发症，包括肺炎2例、急性冠脉综合征1例及切口脂肪液化1例，经保守治疗后均痊愈。未发生吻合口漏、吻合口出血及吻合口狭窄。术后中位随访5.0（1.0~12.0）个月，无肿瘤复发或远处转移，仅1例出现轻度反流症状，经药物治疗后缓解。结论 食管两步切开联合荷包线悬吊技术可优化ROSF吻合流程，提高吻合稳定性并降低操作难度，应用于腹腔镜近端胃切除术安全可行，近期疗效满意。

Abstract:

Background and Aims Right-sided overlap and single-flap valvuloplasty (ROSF) is an important reconstruction method after laparoscopic proximal gastrectomy that balances anti-reflux efficacy and functional preservation. However, conventional ROSF still presents technical challenges in esophageal incision, closure of the common opening, and prevention of esophageal stump retraction. This study aimed to evaluate the safety and feasibility of a modified ROSF technique optimized by esophagus two-step-cut combined with purse-string suspension of the esophageal stump.Methods Clinical data of 33 patients who underwent laparoscopic proximal gastrectomy with modified ROSF reconstruction at the Affiliated Cancer Hospital of Zhengzhou University between August 2024 and December 2025 were retrospectively analyzed. The modified technique included esophagus two-step-cut, purse-string suspension fixation of the esophageal stump, and layered esophageal incision. Perioperative outcomes, postoperative complications, and short-term follow-up results were analyzed.Results All 33 patients successfully completed the operation without conversion to open surgery or perioperative death. The esophagus two-step-cut technique enabled a neat esophageal incision and satisfactory alignment between the mucosal and muscular layers. Purse-string suspension effectively prevented esophageal stump retraction and improved anastomotic stability. The mean ROSF reconstruction time was (37.9±9.7) min. Intraoperative blood loss was (137.2±45.8) mL. The time to first flatus, first liquid intake, and postoperative hospital stay were (2.1±0.5) d, (5.9±0.3) d, and (10.0±3.2) d, respectively. Perioperative complications occurred in 4 patients (12.1%), all classified as Clavien-Dindo grade Ⅰ-Ⅱ, including pneumonia in 2 patients, acute coronary syndrome in 1 patient, and fat liquefaction of the incision in 1 patient. All recovered after conservative treatment. No anastomotic leakage, anastomotic bleeding, or anastomotic stenosis occurred. During a median follow-up of 5.0 (1.0-12.0) months, no tumor recurrence or distant metastasis was observed. Only 1 patient developed mild reflux symptoms, which were relieved with medication.Conclusion Esophagus two-step-cut combined with purse-string suspension can optimize the ROSF procedure by improving anastomotic stability and reducing operative difficulty. This modified technique is safe and feasible for laparoscopic proximal gastrectomy and demonstrates satisfactory short-term outcomes.