目的 对胃中部早期胃癌行内镜黏膜下剥离术（ESD）后追加腹腔镜保留幽门胃切除术（LPPG）与腹腔镜远端胃切除术（LDG）的手术安全性及术后生活质量进行比较。方法 回顾性分析2016年1月至2024年2月南京大学医学院附属鼓楼医院胃与疝外科收治的48例胃中部早期胃癌ESD术后追加外科手术病人的临床及随访资料。根据手术方式的不同，分为LPPG组（9例）与LDG组（39例）。比较两组病人临床病理特征、术后短期结局、术后2年生存和术后生活质量评分。结果 两组均实现R0切除。LPPG组病人年龄小于LDG组，差异有统计学意义（P=0.038）。两组手术时间、术中出血量、淋巴结清扫数目（中位数均为25枚）、术后排气排便时间及住院时间差异均无统计学意义（P>0.05）。LPPG组近端及远端切缘距离均短于LDG组（P=0.001、0.041）。LPPG组术后近期（≤30 d）并发症发生率为22.2%（2/9），LDG组为2.6%（1/39）。术后6个月LPPG组白蛋白水平高于LDG组（45.4 g/L vs. 43.2 g/L，Hedges' g=0.78），但差异无统计学意义（P=0.065）。术后6个月及2年，两组血红蛋白水平差异均无统计学意义（P>0.05）。远期并发症发生率差异无统计学意义（11.1% vs. 17.9%，P>0.05），但并发症类型不同。术后2年生活质量评分组间差异无统计学意义（P>0.05），LPPG组便秘子项评分高于LDG组（P=0.047）。术后2年随访两组均未见肿瘤复发或转移。结论 LPPG 与 LDG 用于胃中部早期胃癌 ESD 术后追加手术均可达到满意的肿瘤学疗效，其中LPPG 在不增加远期并发症和总体生活质量损失的前提下显示出更好的营养保留趋势，但近期并发症发生率偏高、便秘症状较多，更适合有功能保留需求、经严格筛选的病人。

Objective To compare the surgical safety and postoperative quality of life between laparoscopic pylorus-preserving gastrectomy (LPPG) and laparoscopic distal gastrectomy (LDG) following endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the middle of stomach. Methods A single-center retrospective cohort study was conducted on the clinical and follow-up data of 48 patients who underwent additional surgery after ESD for EGC in the middle of stomach at the Department of Gastric and Hernia Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, between January 2016 and February 2024. Patients were divided into two groups based on the surgical procedure: LPPG (n=9) and LDG (n=39). Clinicopathological characteristics, short-term postoperative outcomes, 2-year survival, and postoperative quality of life scores were compared between the two groups. Results R0 resection was achieved in all patients in both groups. Patients in the LPPG group were significantly younger than those in the LDG group (P=0.038). No statistically significant differences were observed between the two groups in operative time, intraoperative blood loss, number of lymph nodes dissected (median 25 in both groups), time to first flatus or defecation, or length of hospital stay (all P>0.05). The proximal and distal resection margins were significantly shorter in the LPPG group than in the LDG group (P=0.001 and P=0.041, respectively). The incidence of short-term (≤30 d) postoperative complications was 22.2% (2/9) in the LPPG group and 2.6% (1/39) in the LDG group. At 6 months postoperatively, serum albumin levels were numerically higher in the LPPG group than in the LDG group (45.4 g/L vs. 43.2 g/L, Hedges’ g=0.78), but the difference did not reach statistical significance (P=0.065). Hemoglobin levels did not differ significantly between the two groups at either 6 months or 2 years postoperatively (P>0.05). The overall incidence of long-term complications did not differ significantly between the two groups (11.1% vs. 17.9%, P>0.05), although the complication spectra differed. At 2 years postoperatively, life quality scores were comparable between the two groups (all P>0.05); the LPPG group had a significantly higher constipation subscale score than the LDG group (P=0.047). No tumor recurrence, lymph node metastasis, or distant metastasis was observed in either group during the 2-year follow-up. Conclusion Both LPPG and LDG can achieve satisfactory oncological outcomes as salvage surgery after ESD for early gastric cancer in the middle stomach. LPPG shows better nutritional preservation without increasing long-term complications or overall QOL loss, but it has higher short-term complication rates and more constipation, thus being more suitable for carefully selected patients requiring function preservation.