引用文本：吴楚营, 叶凯. 改良管型胃side overlap吻合法在腹腔镜近端胃切除术中的操作要点[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(1): 176-180.

作者：吴楚营，叶凯

单位：福建医科大学附属第二医院 胃肠外科，福建 泉州 362000

Authors：Wu Chuying, Ye Kai

Unit：Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Fujian Medical University, Quanzhou 36200, Fujian, China

摘要：

随着食管胃结合部和胃上部癌发病率逐渐升高，腹腔镜近端胃切除术应用日益广泛，但传统食管残胃吻合术后反流性食管炎及吻合口狭窄发生率较高。Yamashita等提出的side overlap吻合法经改良后仍受食管下段游离长度的限制，而Hosogi等发明的改良管型胃side overlap吻合法则解决了食管切缘较高的问题，笔者对此术式进行了进一步的改良。该术式适用于Siewert Ⅱ型食管胃结合部癌，手术操作包括游离食管下段至足够长度，制作管型胃，将食管残端逆时针旋转90°与残胃前壁侧侧吻合，包埋食管下段切缘并重建人工胃底等。改良后的术式具有三大优势：可用于肿瘤位置更高的食管胃结合部癌；狭长管型胃抗反流效果更好；操作简单且费用低，术后吻合口形成类似活瓣的结构，能有效实现抗反流效果。

关键词：食管胃结合部肿瘤；腹腔镜；近端胃切除；管型胃；食管胃侧侧吻合

Abstract：

With the rising incidence of esophagogastric junction and upper gastric cancers, laparoscopic proximal gastrectomy is increasingly being adopted. However, traditional esophagogastric anastomosis is associated with a relatively high incidence of postoperative reflux esophagitis and anastomotic stenosis. Although the side overlap anastomosis technique proposed by Yamashita et al. has undergone modifications, its application remains constrained by the mobilizable length of the lower esophagus. Hosogi et al. introduced a modified tubular gastric side overlap anastomosis method that addressed the issue of a higher esophageal resection margin, and the author has further refined it. This procedure is particularly suitable for Siewert type Ⅱ esophagogastric junction cancer. The surgical steps involve mobilizing the lower esophagus to an adequate length, creating a tubular stomach, rotating the esophageal stump 90 degrees counterclockwise, and performing a side-to-side anastomosis with the anterior wall of the remnant stomach while embedding the lower resection margin and reconstructing an artificial gastric fundus. The modified surgical technique offers three significant advantages: applicability to esophagogastric junction cancer with higher tumor locations; enhanced anti-reflux efficacy due to the long and narrow tubular stomach configuration; and technical simplicity and low cost. Postoperatively, the anastomosis forms a valve-like structure that ensures an effective anti-reflux mechanism.

Key words：Esophagogastric junction neoplasms; Laparoscopy; Proximal gastrectomy; Tubular stomach; Esophagogastric side-to-side anastomosis

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