胃袖状切除术附加手术术式选择及难点

The choice and difficulties of sleevega strectomy plus procedures

随着减重代谢外科不断发展,以胃袖状切除术(SG)为基础的多种创新术式不断涌现。目前的临床证据表明,胃袖状切除术附加手术(SG plus)能增强减重降糖效果,减少手术并发症。由于没有旷置的胃囊,因此术后可以容易施行胃镜检查。近期研究数据显示,胃袖状切除术联合十二指肠-空肠旁路术(SG-DJB)在1年和3年的随访中,多余体重减少百分比(%EWL)分别为95.77%和83.84%,总体重减少百分比(%TWL)分别为34.64%和30.32%,降糖效果和Roux-en-Y胃旁路术(RYGB)类似,胃袖状切除术联合近端空肠旁路术(SG-PJB)研究表明减重效果优于单纯的SG,减重降糖效果类似于RYGB,并发症远低于RYGB。治疗2型糖尿病为目的的手术推荐SG-DJB,对于以减重为主要目的的病人,优先选择SG-PJB,对于有合并反流性食管炎者可以考虑RYGB。SG plus未来仍然需要高质量的研究。

With the continuous development of bariatric and metabolic surgery,a variety of innovative procedures based on sleeve gastrectomy(SG)are emerging.Current clinical evidence indicates that sleeve-plus procedures not only enhance weight loss and hypoglycemic effect but also reduce surgical complications.Since there is no remnant stomach,gastroscopy can be easily performed after surgery.In the 1-year and 3-year follow-ups,the percentage of excess weight loss(%EWL)of sleeve gastrectomy with duodenojejunal bypass(SG-DJB)was 95.77%and 83.84%,and the percentage of total weight loss(%TWL)was 34.64%and 30.32%,respectively.The hypoglycemic effect of sleeve gastrectomy with proximal jejunal bypass(SG-PJB)and SGDJB was similar to Roux-en-Y gastric bypass(RYGB),and the weight loss effect of SG-PJB was superior to SG alone.SGDJB is recommended for alleviating type 2 diabetes.SC-PJB is preferred for patients whose primary objective is weight loss.RYGB surgery can be considered for patients with reflux esophagitis.SG plus surgery still needs high-quality research in thefuture.