摘要目的:设计经纵隔隧道瓣成型法重建贲门结构，评估其在腹腔镜近端胃切除术后消化道重建中的安全性和可行性。方法:选取2024年1至7月中国医学科学院北京协和医学院肿瘤医院手术治疗的11例胃上部癌患者的临床资料。手术方法：腹腔镜游离完毕，距肿瘤上缘2 cm离断食管，取出标本。距肿瘤下缘5 cm裁剪宽度4 cm、长度20 cm管型胃。距残胃顶端2 cm制作长度2 cm、宽度2 cm浆肌瓣隧道。采用Overlap杂交法重建消化道。结果:本组中位手术时间175（139~285）min，中位肌瓣制作时间和重建时间分别为10.5（5.5~21.0）min和15.0（11.8~33.6）min，中位出血量50（20~100）ml，中位术后住院时间8（6~25）d，中位肿瘤大小2.5（1.0~4.0）cm，中位清扫31（15~52）枚淋巴结。术后中位随访时间3.5（0.7~6.0）个月，未见肿瘤复发转移。术后发生1例吻合口漏（Clavien-Dindo分级 Ⅱ级），无围手术期死亡。全组Visick评分1分8例，2分3例，无吻合口狭窄。1例胃镜复查见反流性食管炎（洛杉矶分级B级），经药物治疗后症状缓解。结论:经纵隔隧道瓣成型法手术安全性高，消化道重建难度低、抗反流效果确切。

abstractsObjective:To evaluate a transhiatal tunnel flap designed to reconstruct the cardiac functional structure in proximal gastric cancer patients in our center.Methods:A descriptive case study method was used to select the data of 11 patients undergoing surgery for upper gastric cancer from Jan to Jul 2024. After laparoscopic dissection is completed, the esophagus is transected 2 cm from the upper edge of the tumor and the specimen is removed. The distance from the lower edge of the tumor is 5 cm. The cutting width is 4 cm, and the length of sleeve distal stump stomach is 20 cm. A seromuscular flap tunnel was made with a length of 2 cm and a width of 2 cm, 2 cm away from the top of the remnant stomach. The digestive tract was reconstructed using the Overlap hybridization method.Results:The median operation time was 175 (139-285) minutes. The median muscle flap production time and reconstruction time was 10.5 (5.5-21.0) minutes and 15.0 (11.8-33.6) minutes, respectively. The median blood loss is 50 (20-100) ml. The median postoperative hospitalization was 8 (6-25) days. The median tumor size was 2.5 (1.0-4.0) cm, and 31 (15-52) lymph nodes were dissected. The median follow-up after surgery was 3.5 (0.7-6.0) months, and no tumor recurrence or metastasis was found. Postoperative anastomotic leakage (Clavien-Dindo grade Ⅱ) occurred in one case, and there was no perioperative death. The Visick score of the whole group was 1 point in 8 cases and 2 points in 3 cases, and there was no anastomotic stenosis. Reflux esophagitis (Los Angeles classification grade B) was found in 1 case after gastroscopy, and the symptoms were relieved by conservative treatment.Conclusion:The transhiatal tunnel flap arthroplasty method has high surgical safety, low reconstruction difficulty, and an reliable anti-reflux effect.