目的 探讨双镜联合前哨淋巴结导航手术（LECS-SNNS）策略在不同适应证的早期胃癌病人中的疗效及安全性。方法 回顾性分析2023年8月至2025年11月首都医科大学附属北京友谊医院连续收治的接受LECS-SNNS治疗策略的60例早期胃癌病人的临床病理资料。其中，行内镜黏膜下剥离术（ESD）联合腹腔镜前哨淋巴结引流区清扫（LSBD）13例（ESD-LSBD组）；行内镜-腹腔镜胃区域切除术（LRG）联合LSBD 30例（LRG-LSBD组）；行LSBD 17例（LSBD组）。分析评估临床病理特征、胃排空时间、营养状况、生活质量以及与围手术期并发症。结果 4例病人因前哨淋巴结转移，中转为D2胃癌根治术。除LRG-LSBD组pT1b期占比（73.3%）显著高于其他两组（P<0.05），3组在基线资料和淋巴结检出情况方面差异无统计学意义（P<0.05）。在围手术期指标方面，LSBD组手术时间显著短于LRG-LSBD组（P=0.001），术后住院时间也明显短于其他两组（均P<0.017）；LSBD组和ESD-LSBD组的术中出血量少于LRG-LSBD组（均P<0.017）。3组术后1周的胃半排空时间均显著长于术前，术后3个月均明显改善，且与术前差异无统计学意义（P>0.05）。术后1周，LSBD组的胃半排空时间显著优于LRG-LSBD组（P<0.017），但术后3个月各组间差异无统计学意义（P>0.05）。各组多数营养指标术后1周明显下降，术后3个月恢复至术前水平，且各组间差异无统计学意义。生活质量方面，术后1个月多数指标评分显著下降，术后3个月恢复至术前水平。术后1个月，LSBD组在PGSAS-45评分中的消化不良症状评分和症状总分显著优于LRG-LSBD组（P<0.017），其他量表及术后评分组间差异无统计学意义。术后90 d内，共发生2例并发症，其中Ⅰ、Ⅱ级各1例，均经保守治疗后好转，未发生≥Ⅲ级并发症。结论 早期胃癌LECS-SNNS治疗策略，通过术前精确评估和术中前哨淋巴结导航，为病人个体化选择治疗方案，能够在保证肿瘤R0切除的基础上，兼顾保护器官功能，短期功能学观察结果支持其成为早期胃癌精准治疗的重要实践方向之一。

Objective To explore the efficacy and safety of the laparoscopic-endoscopic cooperative surgery combined sentinel lymph node navigation surgery (LECS-SNNS) strategy in early gastric cancer (EGC) patients with different indications. Methods A retrospective analysis was conducted on the clinicopathological data of 60 consecutive EGC patients who underwent LECS-SNNS at Beijing Friendship Hospital, Capital Medical University, between August 2023 and November 2025. Among them, 13 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node basin dissection (LSBD) (ESD-LSBD group); 30 received laparoscopic-endoscopic regional gastrectomy (LRG) combined with LSBD (LRG-LSBD group); and 17 underwent LSBD alone (LSBD group). Clinicopathological characteristics, gastric emptying time, nutritional status, quality of life (QoL), and perioperative complications were analyzed and evaluated. Results Four patients were converted to standard D2 radical gastrectomy due to sentinel lymph node metastasis. Except for a significantly higher proportion of pT1b (73.3%) stages in the LRG-LSBD group than in the other two groups (P<0.05), no statistically significant differences were observed among the three groups regarding baseline characteristics and the number of detected lymph nodes. Regarding perioperative indicators, the LSBD group had a significantly shorter operative time than the LRG-LSBD group (P=0.001) and a markedly shorter postoperative hospital stay than the other two groups (both P<0.017). Intraoperative blood loss in the LSBD and ESD-LSBD groups was significantly lower than that in the LRG-LSBD group (both P<0.017). The gastric half-emptying time at 1 week postoperatively was significantly longer than the preoperative baseline across all three groups, which markedly improved at 3 months postoperatively, showing no statistically significant difference compared with the preoperative baseline. At 1 week postoperatively, the gastric half-emptying time in the LSBD group was significantly better than that in the LRG-LSBD group (P<0.017), whereas no significant difference was found among the groups at 3 months postoperatively. Most nutritional indicators in each group decreased significantly at 1 week postoperatively and returned to preoperative levels at 3 months postoperatively, with no significant differences observed among the groups. Regarding QoL, scores for most indicators declined significantly at 1 month postoperatively and recovered to preoperative levels at 3 months postoperatively. At 1 month postoperatively, the LSBD group demonstrated significantly better indigestion symptom scores and total symptom scores in the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) than the LRG-LSBD group (P<0.017), while differences in other scales and postoperative scores among the groups were not statistically significant. Within 90 days postoperatively, two complications occurred (one grade I and one grade II), both of which resolved after conservative treatment; no complications of grade ≥ III were observed. Conclusion LECS-SNNS strategy for EGC provides a safe, individualized treatment selection through accurate preoperative assessment and intraoperative lymph node navigation, achieving oncological R0 resection while effectively maximizing short-term organ function and quality of life preservation.