摘要目的：探讨早期食管胃结合部腺癌根治术后消化道重建的理想方式。方法河南科技大学第一附属医院胃肠肿瘤外科前瞻性入组2003年1月至2011年12月接受根治性切除术的Ⅱ型和Ⅲ型早期食管胃结合部腺癌患者153例。按照随机数字表法分为3S吻合组（80例，采用3S空肠间置法吻合）和传统吻合组（73例，采用食管残胃后壁吻合）。观察比较两组患者近、远期并发症发生率、营养指标及术后生活质量。结果3S吻合组与传统吻合组手术时间[（163．2±12．3） min比（154．7±14．1） min]及围手术期并发症发生率[7．5％（6/80）比13．7％（10/73）]的差异均无统计学意义（均P＞0．05）。从术后6月开始，3S吻合组的血清总蛋白、白蛋白、血红蛋白及维生素B12等营养指标均明显高于传统吻合组（均P＜0．05）。术后18月，3S吻合组较传统吻合组反流性食管炎发生率明显降低[20．0％（16/80）比46．6％（34/73）， P＜0．01]，胃排空时间明显延长[（160．8±8．1） min 比（61．1±10．8） min， P＜0．01]。术后QLQ-C30量表调查结果显示，3S吻合组术后生活质量明显高于传统吻合组（P＜0．05）。结论Ⅱ型和Ⅲ型早期食管胃结合部腺癌近端胃切除后采用3S空肠间置法进行消化道重建，具有良好的抗反流效果，可改善患者的远期营养状况和生活质量。

abstractsObjective To investigate the better method of digestive tract reconstruction in proximal gastrectomy for early gastroesophageal junction adenocarcinoma. Methods A total of 153 cases of early gastroesophageal junction adenocarcinoma who were planned to receive radical proximal gastrectomy from January 2003 to December 2011 were prospectively enrolled and randomly divided into two groups by table of random number according to methods of digestive tract reconstruction , including 3S anastomosis group (80 cases, 3S jejunal interposition) and traditional anastomosis group (73 cases, esophageal remnant gastric posterior wall anastomosis). Postoperative complications, operative time, mortality, nutritional parameters and postoperative quality of life were compared between these two groups. Results There were no significant differences between two groups in postoperative complications, operative time and mortality (all P>0.05). 3S anastomosis group was better in nutritional parameters than traditional group six months after operation (P<0.05). As compared to traditional group, incidence of reflux esophagitis decreased [20.0%(16/80) vs. 46.6%(34/73), P<0.01] and gastric emptying time prolonged obviously [(160.8 ±8.1) min vs. (61.1 ±10.8) min, P<0.01] in 3S&nbsp;anastomosis group 18 months after operation. Postoperative QLQ-C30 rating scale revealed quality of life was significantly higher in 3S anastomosis group as compared to traditional group. Conclusion Jejunal interposition is a better method of digestive tract reconstruction in proximal gastrectomy for early gastroesophageal junction carcinoma.