胃袖状切除术附加手术的演变与现状

Current status and evolutions of sleeve gastrectomy plus procedures

胃袖状切除手术(sleeve gastrectomy,SG)因操作简单、疗效确切已成为目前全球减重代谢外科的主流术式,但仍存在复胖率高、术后反流性食管炎发生率高和术后需要修正手术概率高等问题亟待解决。因此,近年来在SG基础上出现了众多附加术式,主要包括:SG加空肠-空肠旁路术、SG加双通路手术、SG联合单吻合口十二指肠回肠旁路术、SG加十二指肠-空肠旁路术等。SG附加手术不断演变与发展,旨在不断追求更佳的治疗效果、更少的术后长短期并发症,未来结合多中心、大样本量、随机对照试验(RCT)研究的佐证,将为建立更理想的减重代谢外科术式奠定基础。

Sleeve gastrectomy(SG)has been a mainstream procedure for metabolic and bariatric surgery(MBS)in the world due to its simple handling and a definite efficacy.However,there are still many shortcoming,such as a high rate of weight gain,a high incidence of postoperative reflux esophagitis and a high probability of postoperative revision surgery.Therefore,based upon sleeve gastrectomy,a large variety of additional procedures have been recently pioneered,including sleeve gastrectomy plus jejunojejunal bypass(SG-JJB),sleeve gastrectomy transit bipartition(SG-TB),single-anastomosis duodenoileal bypass plus sleeve gastrectomy/stomach intestinal pylorus-sparing(SADI-S/SIPS),and sleeve gastrectomy plus duodenojejunal bypass(SG-DJB).Better outcomes have been obtained with fewer long/short-term postoperative complications.In the future,multi-center,larger sample size and randomized controlled trials shall offer more optimized procedures for MBS.