胃袖状切除术联合单吻合口十二指肠-回肠旁路术的价值、问题及对策

The value,existing problems and countermeasures of single anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of obesity and metabolic diseases

作为胆胰分流并十二指肠转位术(BPD-DS)的改良术式,胃袖状切除术联合单吻合口十二指肠-回肠旁路术(SADI-S)对肥胖及代谢病的疗效非常显著,且远大于胃袖状切除术和Roux-en-Y胃旁路术,且较后者具有更低的操作难度和更少的手术并发症。应充分肯定SADI-S在治疗肥胖及代谢病中的价值。然而,SADI-S术后仍有少数病人发生营养不良性肝病、低蛋白血症、胆汁反流等问题,是SADI-S术后行修正手术的主要原因,正视这些问题有利于更好地将这一术式服务于肥胖病人的治疗。术前严格筛查病人、术中精确测量肠道并制定“个性化”共同通道参数及术后严密随访是减少SADI-S术后发生营养不良和反流的有效措施。

As a revision surgery of biliopancreatic diversion with duodenal switch(BPD-DS),single anastomosis duodenalileal bypass with sleeve gastrectomy(SADI-S)has shown a very significant curative effect on obesity and metabolic diseases,and its effect is much greater than sleeve gastrectomy and Roux-en-Y gastric bypass,and it has lower operation difficulty and fewer surgical complications than the later.Therefore,the value of SADI-S in the treatment of obesity and metabolic diseases should be fully affirmed.Nevertheless,there are still a small number of patients who experienced dystrophic liver disease,hypoalbuminemia,and bile reflux after SADI-S,which is the major reason for revision surgery,facing these problems is conducive to better use of this operation in the treatment of patients with obesity.Based on the existing literature and the author's experience,we suggests that strict preoperative screening for patients,precise measurement of intestine during operation,formulation“personalized”common channel parameters,andstrict postoperative follow-up are effective measures to reduce malnutrition and reflux after SADI-S.