中国腹腔镜减重与代谢外科术式选择与原则

Choiceand principles of laparoscopicmetabolic and Bariatric surgeryin China

我国减重与代谢外科已正式步人快速发展期,除了胃袖状切除术和Roux-en-Y胃旁路术外,还有多种术式在临床开展,其中包括单吻合口胃旁路术、胆胰分流并十二指肠转位术、单吻合口十二指肠转位术、胃袖状切除术联合近段空肠旁路术、胃袖状切除术联合十二指肠空肠旁路术、胃袖状切除术联合胃空肠双通道术等,对于未经过系统理论知识和临床实践培训、以及新近开展减重与代谢手术的医生,手术方式的选择常造成困惑。原则是甄别积极推荐、谨慎推荐、不推荐和探索性的手术方式,根据自身条件、团队条件、硬件条件以及患者疾病情况和期望,采用医患共同决策的模式,科学选择手术方式。

Metabolic and bariatric surgery in China has entered a period of rapid development.In addition to sleeve gastrectomy and Roux-en-Y gastric bypass,there are also a variety of surgical procedures emerging in clinical practice,including one anastomotic gastric bypass,biliopancreatic diversion with duodenal switch,single anastomotic duodenal-ileal bypass with sleeve gastrectomy,duodenojejunal bypass with sleeve gastrectomy,jejunal-jejunal bypass with sleeve gastrectomy,gastrojejunal transit bipartition with sleeve gastrectomy,etc.For surgeons who have not experienced systematic theoretical knowledge and clinical practice training,and who have recently started metabolic and bariatric surgery practice,the choice of surgical procedures often creates confusion.The principle is to identify the surgical methods that are strongly recommended,cautiously recommended,not recommended and investigational.According to surgon's own capability,team capability,availability of facility and equipment,as well as patients comorbidities and expectations,the mode of shared decision-making between surgeons and patients should be adopted to objectively select an appropriate surgical procedure.