胃袖状切除联合双通道手术的选择与争议

Selection and controversies of sleeve gastrectomy with transit bipartition procedures

  • 摘要: 胃袖状切除联合双通道手术是一种兼具代谢获益与较低营养不良风险的新型减重代谢手术方式。然而,由于Roux‑en‑Y 吻合双通道手术技术复杂,临床上逐渐发展出多种衍生手术方式,如单吻合口胃袖状切除回肠旁路术(SASI)、单吻合口胃袖状切除空肠旁路术(SAS‑J)以及胃袖状切除联合布朗吻合双通道手术(B‑TB)。各手术方式在操作复杂度、减重代谢效果、营养吸收及抗反流能力等方面各具特点。SASI手术方式相对简单,但存在胆汁反流的潜在风险;SAS‑J更强调营养安全性;而B‑TB通过追加Braun吻合,具有抗反流优势。笔者通过比较上述手术方式的临床特点与适应人群,探讨其优劣势及争议焦点,旨在为外科医师选择个体化减重代谢手术方案提供参考依据。

     

    Abstract: Sleeve gastrectomy with transit bipartition is a novel bariatric and metabolic procedure providing significant metabolic benefits while minimizing the risk of malnutrition. However, due to the technical complexity of the Roux‑en‑Y transit bipartition configuration, several derivative procedures have been developed in clinical practice, including single anastomosis sleeve ileal bypass (SASI), single anastomosis sleeve jejunal bypass (SAS‑J), and sleeve gastrectomy with Braun anasto-mosis transit bipartition (B‑TB). These procedures vary in complexity, weight loss and metabolic efficacy, nutritional impact, and anti‑reflux properties. SASI offers technical simplicity but raises concerns about bile reflux. SAS‑J emphasizes nutritional safety, whereas B‑TB incorporates a Braun anastomosis to enhance anti‑reflux protection. The authors review and compare the clinical charac-teristics and indications of these procedures, aiming to provide a reference for surgeons in selecting individualized metabolic and bariatric surgical strategies.

     

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