减重手术中小肠绕道技术的应用现状与展望

Current status and prospects of the jejunoileal bypass in bariatric surgery

减重手术是治疗肥胖症及其代谢性疾病的有效方法。目前,小肠绕道技术在各类减重手术中广泛应用,但由于小肠绕道后重新构建的解剖结构对于肥胖症患者正常生理功能的影响尚未阐明。因此,胃旁路术等减重手术中推荐的小肠绕道长度存在争议,标准的胃旁路术在实施过程中最佳的胆支和食物支长度也缺乏共识。目前大部分减重手术中并未精确地测量共同支长度以及全部小肠长度,这不可避免地造成减重手术中小肠绕道长度过短导致减重效果不理想或小肠绕道长度过长引起吸收障碍、营养不良等问题。为此,笔者在本文中探讨不同长度胆支、食物支以及共同支对减轻体质量、降低血糖效果的影响,介绍全部小肠长度测量等小肠绕道技术在减重手术中的应用现状与展望。

Bariatric surgery is an effective treatment for obesity and the related metabolic diseases. At present, although the jejunoileal bypass is widely used in various types of bariatric surgery, the effect of reconstructed anatomy after the jejunoileal bypass on normal physiological function of obese patients has not been clarified. This leaves some controversy about the recommended limb lengths in jejunoileal bypass. At the same time, there is no consensus on the optimal biliary limb length and alimentary limb length in the standard gastric bypass. Lack of accurate measurement of common limb length and total small bowel length inevitably results in unsatisfactory percentage of excess body weight loss caused by short limb length, or malabsorption and malnutrition caused by long limb length. The authors discussed the effects of different length of biliary limb, alimentary limb and common limb on weight loss, and introduced the preliminary application and prospects of the jejunoileal bypass including measurement of total small bowel length in bariatric surgery.