[Preliminary exploration of modified side overlap with fundoplication by Yamashita (mSOFY) anastomosis technique in laparoscopic proximal gastrectomy].

Objective: To discuss the feasibility and safety of modified side overlap with fundoplication by Yamashita (mSOFY) in laparoscopic proximal gastrectomy. Methods: Using the method of descriptive case series study, the clinical data of 9 patients with upper gastric cancer who successfully performed mSOFY anastomosis from March 2022 to October 2022 in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University were retrospectively analyzed.The reconstruction steps of mSOFY anastomosis are as follows: (1) Make a small incision on the right side of the esophageal stump and in front of the anterior wall of the gastric stump; (2) The 45mm linear cutting stapler is placed into the preset anastomosis of the esophagus and the remnant stomach, and the esophagus is rotated 90° counterclockwise along the axis, so that the right wall of the esophagus is anastomosed with the remnant stomach, and the stomach wall is sutured to the left side of the esophagus; (3) The common opening of esophagus and remnant stomach was sutured with inverted suture; (4)Suture the left and lower sides of the esophagus with the remnant stomach to make the esophagus flat against the stomach wall; (5) Open the sutured common opening: due to the pressure of the false dome, the posterior wall of the lower esophageal segment was compressed into a valve-like structure. We mainly observing the postoperative reflux and nutritional improvement of the patients, and recording the intraoperative situation and postoperative complications. Results: Nine patients with upper gastric cancer who completed laparoscopic proximal gastrectomy (mSOFY anastomosis) did not have conversion to laparotomy or intraoperative / postoperative complications. The operation time was (169.4±10.4) minutes, the anastomotic reconstruction time was (51.7±7.1) minutes, the intraoperative bleeding volume was (98.9±43.4) ml, and the number of lymph nodes dissected was (27.2±6.7). The patient recovered well after operation, without any complaints related to reflux esophagitis. Postoperative gastrointestinal radiography showed that the anastomosis was smooth, without stenosis and leakage. The serum albumin [(41.6±3.4) L vs. (39.9±2.6) L], prealbumin [(211.3±38.6) mg/L vs. (205.3±36.0) mg/L], and hemoglobin levels [(126.7±13.2) g/L vs. (121.0±9.7) g/L] of patients before and one month after surgery have no statistically significant differences (all P>0.05). Conclusion: mSOFY anastomosis can be used as one of the safe and feasible reconstruction methods in laparoscopic proximal gastrectomy.目的： 讨论改良食管胃侧壁吻合术（mSOFY）在腹腔镜下近端胃切除术中的可行性和安全性。 方法： 采用描述性病例系列研究方法，回顾性分析由南京医科大学附属淮安第一医院2022年3月至2022年10月成功实施mSOFY吻合技术的9例胃上部癌患者的临床诊治资料。mSOFY吻合的重建步骤如下：（1）食管残端右侧和残胃前壁前各做一小切口；（2）45 mm线性切割吻合器置入食管和残胃的预置吻合口，将食管沿轴线逆时针旋转90°，食管右侧壁与残胃吻合，从而将胃壁缝合至食管左侧；（3）倒刺缝线缝合食管和残胃共同开口；（4）将食管左、下侧与残胃缝合，使食管平贴于胃壁；（5）打开缝合完毕的共同开口：由于假穹窿的压力，食管下段后壁被压扁成类似阀门状的结构。主要观察患者术后反流情况和营养改善情况，并记录术中情况和术后并发症发生情况。 结果： 9例完成腹腔镜下近端胃切除术（mSOFY吻合）的胃上部癌患者均未出现中转开腹及术中和术后并发症。手术时间为（169.4±10.4）min，吻合重建时间为（51.7±7.1）min，术中出血量为（98.9±43.4）ml，清扫淋巴结数为（27.2±6.7）枚。患者术后恢复良好，无主诉反流性食管炎；术后消化道造影提示吻合口通畅，无狭窄及吻合口漏。患者术前与术后1个月血清白蛋白［（41.6±3.4）g/L比（39.9±2.6）g/L］、血清前白蛋白［（211.3±38.6）mg/L比（205.3±36.0）mg/L］和血红蛋白［（126.7±13.2）g/L比（121.0±9.7）g/L］比较，差异均无统计学意义（P>0.05）。 结论： mSOFY吻合技术可作为腹腔镜下近端胃切除术中安全可行的重建方法之一。.