探讨食管优先离断系膜边界化胃癌根治术在腹腔镜全胃切除术中的应用价值，通过优化手术流程提升根治质量与操作效率。

回顾性分析2024年2月至2024年12月河南省肿瘤医院收治的28例胃癌患者临床资料。所有患者均采用"先离断食管再行全胃边界化系膜切除"的术式，即在腹腔镜探查后首先游离并离断食管，继而精准界定胃左/胃后系膜、胃右系膜、胃网膜右系膜、胃网膜左/胃短系膜的解剖边界完成全系膜切除。观察镜下手术时间、术中出血量、食管切缘情况、淋巴结清扫数目、术后并发症发生率等指标。

28例患者均顺利完成手术，无中转开腹。镜下手术时间75.21±5.03 min，术中出血量85.14±28.92 ml，淋巴结清扫数目32.14±11.56枚，术后并发症发生率3.6%(1/28)。术后中位随访8.3个月，无肿瘤复发或转移，所有患者食管切缘术中冰冻病理均为阴性。

食管优先离断系膜边界化胃癌根治术可通过早期明确食管切缘、优化系膜暴露路径，实现标准化手术操作，在保证根治效果的同时提升手术效率，安全可行。

To explore the application value of prior esophageal trisection with mesenteric boundary-oriented radical gastrectomy in laparoscopic total gastrectomy for gastric cancer, and to improve the quality of radical resection and operational efficiency through optimizing the surgical procedure.

The clinical data of 28 gastric cancer patients admitted to Henan Cancer Hospital from Feb. 2024 to Dec. 2024 were retrospectively analyzed. All patients underwent the surgical procedure of "trisecting the esophagus first and then performing total gastric mesenteric boundary resection" , which involved freeing and trisecting the esophagus after laparoscopic exploration, and then accurately defining the anatomical boundaries of the left/gastric posterior mesentery, right gastric mesentery, right gastroepiploic mesentery, and left gastroepiploic/short gastric mesentery to complete total mesenteric resection. The indicators observed included intraoperative time under laparoscopy, intraoperative blood loss, esophageal margin status, number of lymph nodes dissected, and incidence of postoperative complications.

All 28 patients successfully completed the surgery without conversion to open surgery. The intraoperative time under laparoscopy was 75.21±5.03 minutes, intraoperative blood loss was 85.14±28.92 ml, the number of lymph nodes dissected was 32.14±11.56, and the incidence of postoperative complications was 3.6%(1/28). The median follow-up period was 8.3 months, with no tumor recurrence or metastasis, and intraoperative frozen section of the esophageal margin confirmed negative in all patients.

Prior esophageal trisection with mesenteric boundary-oriented radical gastrectomy can achieve standardized surgical operation by early clarification of the esophageal margin and optimization of the mesenteric exposure path, improve surgical efficiency while ensuring radical resection, and is safe and feasible.