单吻合口十二指肠回肠吻合术后吻合口位置重建

Bowel reconstruction after single anastomosis duodenal-ileal bypass

单吻合口十二指肠回肠吻合术是相对较新的减重与代谢外科技术,其常联合胃袖状切除术作为一期减重手术方式,或作为胃袖状切除术后二期手术,或作为复胖后修正手术。十二指肠回肠吻合位置通常距离回盲部250~300 cm,但不同个体间全小肠长度不等。若全小肠长度过长,共同支则相对过短,导致严重营养不良;若全小肠长度过短,共同支则相对过长,导致减重效果不佳。针对此问题,笔者提出根据共同支与全小肠长度比值决定吻合口位置,以期达到满意减重效果同时,避免营养不良并发症。

Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy(SADI-S)is a relatively new bariatric surgery procedure,which is ether as a first stage bariatric procedure or second stage surgery following sleeve gastrectomy,or a revisional procedure for unsatisfied weight loss or weight regain following sleeve gastrectomy.Usually the duodenal-ileal anastomosis in SADI-S procedure is made at 250 cm to 300 cm from ileocecal valve.However,as the whole bowel length is quite different,a fixed measurement of only biliopancreatic limb or common limb could result in either too short or too long absorptive bowel leading to life-threatening nutritional deficiencies on the one hand,or insufficient weight loss on the other.In response to this issue,the author proposes to determine the position of anastomosis based on the ratio of common limb length and total bowel length,in order to achieve satisfactory weight loss and avoid malnutrition complications.