目的：探讨腹腔镜下近端胃切除术治疗近端早期胃癌的可行性与安全性。 方法：回顾性分析2007 年6 月—2010 年12 月间手术治疗的72 例近端早期胃癌患者资料，其中38 例 行腹腔镜下近端胃切除术（LAPG 组），34 例行腹腔镜下胃大部切除术（LAG 组）。比较两组患者的 一般情况、术中与术后各项指标，并用Visick 评分比较两组患者术后胃食管反流症状。 结果：两组患者年龄、性别、体质量指数、并存疾病、手术时间及术后住院天数差异均无统计学意义（均 P>0.05），但LAPG 组术中出血量明显少于LAG 组（P<0.05）。两组患者术后肛门排气时间、开始进 食时间及早、晚期并发症发生率差异均无统计学意义（均P>0.05），但LAPG 组术后Visick 评分明显 高于LAG 组（P<0.05）。两组患者术后病理指标、手术前后的营养学指标变化、术后生存率差异均无 统计学意义（均P>0.05）。 结论：腹腔镜下近端胃切除术能够安全的应用于近端早期胃癌的治疗，但应警惕术后胃食管反流症状 的发生。
Laparoscopy-assisted proximal gastrectomy for early-stage proximal gastric cancer
Objective: To evaluate feasibility and safety of laparoscopy-assisted proximal gastrectomy in treatment of earlystage proximal gastric cancer. Methods: The clinical data of 72 patients with early-stage proximal gastric cancer undergoing surgical treatment from June 2007 to December 2010 were retrospectively analyzed. Of the patients, 38 cases underwent laparoscopy-assisted proximal gastrectomy (LAPG group) and laparoscopy-assisted subtotal gastrectomy (LAG group). The general conditions, intra- and postoperative variables were compared, and the symptoms of gastroesophageal reflux after surgery between the two groups were also compared by using Visick score. Results: No significant difference was noted in age, gender, body mass index, concomitant disease, operative time and length of postoperative hospital stay between the two groups (all P>0.05), but the intraoperative blood loss in LAPG group was significantly reduced compared with LAG group (P<0.05). The time to first postoperative flatus and food intake, and incidence of early and delayed complications after surgery showed no significant difference between the two groups (all P>0.05), but the postoperative Visick score in LAPG group was significantly higher than that in LAG group (P<0.05). The postoperative pathological parameters, pre- and postoperative changes in nutritional parameters and postoperative survival rate between the two groups showed no significant difference (all P>0.05). Conclusion: laparoscopy-assisted proximal gastrectomy can be safely used in treatment of early proximal gastric cancer and however, the occurrence of postoperative gastroesophageal reflux should be monitored carefully.