引用文本：陈妍, 熊文俊, 罗立杰, 等. 空肠营养管置入联合术后肠内营养在腹腔镜经腹膈肌入路Siewert Ⅱ型食管胃结合部腺癌根治术患者中的应用价值[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(2): 255-263.

作者：陈妍1，熊文俊1，罗立杰1，林泽宇2，张子敬1，王涛1，彭耀辉1，杨海淦1，李金1，张焯铉3，王伟1

单位：1. 广州中医药大学第一附属医院胃肠外科，广东省中医临床研究院，广东 广州 510405；2. 广州中医药大学第一临床医学院，广东 广州 510405；3. 广州中医药大学第二临床医学院，广东 广州 510405

Authors：Chen Yan1, Xiong Wenjun1, Luo Lijie1, Lin Zeyu2, Zhang Zijing1, Wang Tao1, Peng Yaohui1, Yang Haigang1, Li Jin1, Zhang Zhuoxuan3, Wang Wei1

Unit：1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou 510405, Guangdong, China；2. The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China；3. The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China

摘要：

目的 探讨术中经腹放置空肠营养管及术后早期肠内营养在行腹腔镜经腹膈肌入路Siewert Ⅱ型食管胃结合部腺癌（adenocarcinoma of esophagogastric junction, AEG）根治术患者中的应用价值。方法 选取2023年7月至2025年8月，于广州中医药大学第一附属医院行腹腔镜经腹膈肌入路Siewert Ⅱ型AEG根治术，且术中经腹放置空肠营养管联合术后早期肠内营养的29例患者。采用描述性病例系列研究方法，记录患者手术相关指标、术后恢复指标、营养状态及术后早期并发症发生情况。结果 29例患者均顺利完成手术，无围手术期死亡病例。手术时间为305（235~513） min，术中出血量为50（10~400） ml，吻合口距离（食管胃或食管空肠吻合口到食管裂孔的距离）为6（6~8） cm。术后首次下床时间为2（1~4） d，首次排气时间为3（1~6） d，恢复全流质饮食时间为6（2~14） d，胸腔引流管拔除时间为9（6~31） d，术后住院天数为14（8~39） d。术前合并营养不良（营养风险筛查2002评分≥3分）的患者有21例（72.41%），术后1个月合并营养不良的患者数量降至14例（48.28%）。术后早期无吻合口漏发生。2例（6.90%）患者出现术后早期Clavien-Dindo Ⅲa级并发症，均为胸腔积液，通过胸腔穿刺、抗感染等治疗后好转出院。1例（3.45%）患者出现乳糜漏（Clavien-Dindo Ⅱ级），在暂停肠内营养后，予禁食联合肠外营养、持续引流、生长抑素药物治疗1周，待乳糜试验阴性后恢复肠内营养，最终患者顺利恢复并出院。1例（3.45%）患者出现空肠营养管堵管（Clavien-Dindo Ⅰ级），使用导丝疏通导管后恢复正常肠内营养。1例（3.45%）患者出现腹泻（Clavien-Dindo Ⅰ级），暂停肠内营养并经对症治疗3 d后好转，而后继续给予肠内营养也未再发腹泻。结论 对于行腹腔镜经腹膈肌入路Siewert Ⅱ型AEG根治术的患者，术中经腹放置空肠营养管联合术后早期肠内营养的应用初步显示安全可行；其在改善营养状态、降低吻合口漏等并发症发生率方面，可能具有一定积极作用。

关键词：食管胃结合部腺癌；腹腔镜手术；胸腔内吻合；空肠营养管

Abstract：

Objective To explore the application value of intraoperative transabdominal placement of jejunal nutrition tube for postoperative early enteral nutrition in patients undergoing laparoscopic transphrenic radical resection for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). Method A total of 29 patients who underwent laparoscopic transphrenic radical resection for Siewert type Ⅱ AEG, and received intraoperative transabdominal placement of jejunal nutrition tube for early postoperative enteral nutrition, were enrolled from July 2023 to August 2025 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A descriptive case series study was adopted, and the surgical indicators, the postoperative recovery indicators, nutritional status and the occurrence of early postoperative complications of the patients were recorded. Result All patients underwent laparoscopic surgery successfully without perioperative death. The operative time, intraoperative blood loss, and anastomotic distance (the distance between the esophagogastric or esophagojejunal anastomosis and the esophageal hiatus) were 305 (235-513) minutes, 50(10-400) ml, and 6(6-8) cm, respectively. The time to first ambulation postoperatively, time to first anal exhaust, time to resume full fluid diet, the thoracic drainage tube removal time, and the postoperative hospital stay were 2(1-4), 3(1-6), 6(2-14), 9(6-31), and 14(8-39) days, respectively. Preoperative malnutrition (nutritional risk screening 2002 score≥3) accounted for 21 cases (72.41%), and the number of patients with malnutrition decreased to 14 cases (48.28%) one month after surgery. During the early postoperative period, no anastomotic leakage occurred. Two patients (6.90%) experienced Clavien-Dindo grade Ⅲa complications, which were pleural effusions. After thoracentesis and antibiotic therapy, the patients were discharged. One patients (3.45%) developed chylous leakage (Clavien-Dindo grade Ⅱ). After one week of comprehensive treatment including suspension of enteral nutrition, fasting combined with parenteral nutrition, continuous drainage, and somatostatin administration, enteral nutrition was resumed following a negative chylous test, and the patient was successfully discharged with complete recovery. One patient (3.45%) had a blocked jejunal nutrition tube (Clavien-Dindo grade Ⅰ). After the tube was unblocked with a guide wire, enteral nutrition was resumed. One patient (3.45%) experienced diarrhea (Clavien-Dindo grade Ⅰ), which resolved within three days after discontinuation of enteral nutrition and symptomatic treatment, and did not recur upon resumption of enteral nutrition. Conclusion The intraoperative transabdominal placement of jejunal nutrition tube and early postoperative enteral nutrition appears to be safe and feasible in patients undergoing laparoscopic transphrenic radical resection for Siewert type Ⅱ AEG. It may have certain positive effects in improving nutritional status and reducing the incidence of complications such as anastomotic leakage.

Key words：Adenocarcinoma of the esophagogastric junction; Laparoscopic surgery; Intrathoracic anastomosis; Jejunal nutrition tube

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