一种新型梯形隧道式食管胃吻合在近端胃切除中的应用初探（附视频）

Preliminary application of a novel trapezoid-shaped tunnel esophagogastrostomy in proximal gastrectomy (with video)

摘要:

背景与目的 近端胃切除术可保留部分胃功能，但术后反流性食管炎及吻合口狭窄仍是限制其推广的重要问题。传统双肌瓣吻合术虽具有较好的抗反流效果，但存在浆肌瓣血供受损、吻合口狭窄发生率较高及操作复杂等不足。本研究基于既往隧道式吻合术进一步改良，提出梯形隧道式吻合术（tTunnel法），旨在探讨其在近端胃切除消化道重建中的安全性、可行性及近期疗效。方法 回顾性分析2024年8月—2025年4月江苏省肿瘤医院30例接受根治性近端胃切除联合tTunnel法重建的近端胃癌患者临床资料。观察指标包括手术结果、术后恢复情况、围手术期并发症、反流性食管炎发生情况、吻合口狭窄发生率、胃食管反流病量表（RDQ）评分及胃镜随访结果。结果 30例患者均顺利完成手术，其中机器人手术9例、腹腔镜手术17例、开放手术4例。手术总时间为（297.1±82.25）min，梯形隧道制作时间为（8.0±2.05）min，手工吻合时间为（52.4±9.59）min，术中出血量为（41.3±19.01）mL。所有患者均达到R₀切除。围手术期并发症发生率为20.0%（6/30），Clavien-Dindo并发症分级≥Ⅲ级1例（3.3%）。术后胃镜检查发现吻合口狭窄2例（6.7%），均为出口型狭窄，无入口型狭窄；反流性食管炎3例（10.0%），均为轻度（A级1例、B级2例）。RDQ评分术后逐渐下降，所有患者均未出现明显反流症状。结论 tTunnel法应用于近端胃切除术后消化道重建安全可行，具有较好的抗反流效果及较低的吻合口狭窄发生率，尤其可降低入口型狭窄风险。该术式操作相对简化，具有一定临床推广价值，但其远期疗效仍需大样本前瞻性研究进一步验证。

Abstract:

Background and Aims Although proximal gastrectomy preserves partial gastric function, postoperative reflux esophagitis and anastomotic stricture remain major challenges. The double-flap technique provides satisfactory anti-reflux efficacy but is limited by impaired blood supply to the seromuscular flap, a relatively high incidence of anastomotic stricture, and technical complexity. Based on the previously developed tunnel anastomosis, we further designed a trapezoid-shaped tunnel anastomosis (tTunnel method). This study aimed to evaluate the safety, feasibility, and short-term efficacy of this modified reconstruction technique after proximal gastrectomy.Methods Clinical data of 30 patients with proximal gastric cancer who underwent radical proximal gastrectomy combined with the tTunnel method at Jiangsu Cancer Hospital between August 2024 and April 2025 were retrospectively analyzed. Operative outcomes, postoperative recovery, perioperative complications, reflux esophagitis, anastomotic stricture, Reflux Disease Questionnaire (RDQ) scores, and endoscopic findings were evaluated.Results All 30 patients successfully underwent proximal gastrectomy with tTunnel reconstruction, including 9 robotic, 17 laparoscopic, and 4 open procedures. The mean operative time was (297.1±82.25) min, tunnel creation time was (8.0±2.05) min, hand-sewn anastomosis time was (52.4±9.59) min, and intraoperative blood loss was (41.3±19.01) mL. R₀ resection was achieved in all patients. The overall perioperative complication rate was 20.0% (6/30), with one patient (3.3%) experiencing a Clavien-Dindo grade ≥Ⅲ complication. Follow-up endoscopy revealed anastomotic stricture in 2 patients (6.7%), both classified as outlet-type strictures, while no inlet-type stricture was observed. Reflux esophagitis occurred in 3 patients (10.0%), all of whom had mild disease (Grade A in 1 patient and Grade B in 2 patients). RDQ scores gradually decreased during follow-up, and no patient experienced clinically significant reflux symptoms.Conclusion The tTunnel method is safe and feasible for digestive tract reconstruction after proximal gastrectomy. It provides satisfactory anti-reflux efficacy with a relatively low incidence of anastomotic stricture, particularly reducing the risk of inlet-type stricture. Owing to its simplified procedure, this technique may have promising clinical applicability. However, its long-term outcomes require further validation in large-scale prospective studies.