外科理论与实践 ›› 2020, Vol. 25 ›› Issue (05): 391-396.doi: 10.16139/j.1007-9610.2020.05.008
朱孝成(
), 侯栋升
收稿日期:2020-07-28
出版日期:2020-09-25
发布日期:2022-07-27
通讯作者:
朱孝成
E-mail:zhuxccf@163.com
ZHU Xiaocheng(), HOU Dongsheng
Received:2020-07-28
Online:2020-09-25
Published:2022-07-27
中图分类号:
朱孝成, 侯栋升. 新型减重代谢手术方式：袖状胃切除加双通路[J]. 外科理论与实践, 2020, 25(05): 391-396.
ZHU Xiaocheng, HOU Dongsheng. New type of bariatric and metabolic procedure: sleeve gastrectomy with transit bipartition[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 391-396.
图1
袖状胃加手术方式 A：SG;B：胆胰转流十二指肠转位术（biliopancreatic diversion with duodenal switch, BPD-DS）;C：单吻合口十二指肠回肠转位术（single anastomosis duodenal-ileal switch, SADIS）;D：十二指肠空肠旁路术（duodenal-jejunal bypass, DJB）;E：间置回肠术（ileal interposition, IT）;F：双通路术（transit bipartition, TB）
图2
SG-TB 回肠-回肠吻合距离回盲部220 cm;胃-回肠吻合距离回肠-回肠吻合40 cm
表1
SG-TB的手术方式及效果
| 参考文献 | n | 手术方式 | BMI | 糖化血红蛋白 | 糖尿病 缓解率(%) | 随访 时间(年) | |||
|---|---|---|---|---|---|---|---|---|---|
| 术前 | 术后 | ||||||||
| 术前 | 术后 | ||||||||
| Santoro等[ | 1 020 | Bougie=36Fr 胃-回肠吻合：吻合口直径3 cm, 距离回盲部260 cm 回肠-回肠吻合：距离回盲部80 cm | 42.2 | %EBMIL 74.0%±22.5% | - | - | 86 | 5 | |
| Mahdy等[ | 551(多 中心) | 单吻合TB Bougie=36Fr 胃-回肠吻合：吻合口直径<3 cm, 距离回盲部250 cm | 43.2±12.5 | 31.1±9.7 | 8.1±3.6 | 5.3±2.6 | 83.9 | 1 | |
| Mahdy等[ | 50 | 单吻合TB Bougie=36Fr 胃-回肠吻合：吻合口直径<3 cm, 距离回盲部250 cm | 48.7±7.6 | %EBMIL 90% | 9.9±2.7 | 5.1±0.8 | 100 | 1 | |
| Topart等[ | 71 | Bougie=50Fr 胃-回肠吻合：吻合口直径3 cm, 距离回盲部250 cm 回肠-回肠吻合：距离回盲部100 cm | 51.6±5.0 | 29.2±4.5 | - | - | 80 | 2 | |
| Yormaz等[ | 19 | 胃-回肠吻合：距离屈氏韧带150 cm 回肠-回肠吻合：距离回盲部80 cm | 36.6±2.1 | 25.5±2.2 | 9.0±1.2 | 6.0±1.5 | 82.9 | 1 | |
| Emile等[ | 58(多 中心) | 单吻合TB Bougie=36Fr 胃-回肠吻合：吻合口直径<3 cm, 距离回盲部250 cm | 48.9±16.9 | 30.6±5.5 | - | - | 95.8 | 1 | |
| Bilecik[ | 35 | 胃-回肠吻合：吻合口直径3~4 cm, 距离回盲部260 cm 回肠-回肠吻合：距离回盲部80 cm | 42.0±1.3 | 24.8±1.6 | 9.1±1.0 | 5.2±0.4 | 88.6 | 1 | |
| Azevedo等[ | 10 | 胃-回肠吻合：吻合口直径3 cm, 距离回盲部250~260 cm 回肠-回肠吻合：距离回盲部120~130 cm | 33.4±2.6 | 30.9±2.5 | 9.3±2.1 | 5.5±1.1 | 90 | 2 | |
| Karaca[ | 45 | Bougie=33Fr~45Fr 胃-回肠吻合：吻合口直径3.5~4.5 cm, 距离肠肠吻合150 cm 回肠-回肠吻合：距离回盲部80~120 cm | 38.0±8.7 | 24.8±2.4 | 9.1±1.3 | 5.6±0.6 | 88.8 | 1 | |
| Rodrigues等[ | 9 | 胃-回肠吻合：距离回盲部260 cm 回肠-回肠吻合：距离回盲部80 cm | 31.2±2.2 | 减少22.8% | 10.6±0.6 | 6.7±0.1 (术后3个月) | 78 | 1 | |
表2
SG-TB术后并发症
| 参考文献 | n | 随访时间（年） | 胆结石（n） | 吻合 口漏 （n） | 出血 （n） | 疝/梗阻（n） | 溃疡（n） | 腹泻 (>3次/d) | 贫血 （n） | 低蛋白 血症（n） | 反流(n) | 肺血 栓（n） | 其他（n） | 死亡 率 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Santoro等[ | 1 020 | 5 | 132 | 9 | 8 | 19(切口疝) 15(内疝或不完全性肠梗阻) 3(食管裂孔疝) | 1(吻合口溃疡) | - | - | - | 35% | 1 | 3(胃肠吻合口狭窄) 2(神经压迫) | 0.20% |
| Mahdy等[ 单吻合TB | 551 | 1 | - | - | 1 | 1(肠梗阻) | 3(胃溃疡) | 15 | - | - | - | 1 | 32( 胆汁性呕吐) 2(梗阻性黄疸) 1(回肠穿孔) | 0 |
| Mahdy等[ 单吻合TB | 50 | 1 | - | 1 | 1 | 1(完全性梗阻) | 1(吻合口溃疡) | 2 | - | 1(轻度) | - | 1 | - | 0 |
| Topart等[ | 71 | 2 | - | - | - | 1.4%(内疝) | - | 7% | - | 6.5%(轻度) 1.4%(严重) | - | - | - | 0 |
| Emile等[ 单吻合TB | 58 | 1 | - | - | 1 | 1(肠梗阻) | - | - | - | - | - | - | 2(肺炎) | 0 |
| Bilecik[ | 35 | 1 | 1 | - | - | 1(不完全性肠梗阻) | - | - | - | - | - | - | 4(恶心呕吐) | 0 |
| Azevedo等[ | 10 | 1 | 1 | - | - | - | - | - | 1 | 1 | - | - | - | 0 |
| Karaca[ | 45 | 1 | 3 | - | - | - | - | - | - | - | 6 | - | 1(神经压迫) | 0 |
图3
本院SG-TB手术过程 A：完成标准SG(采用36Fr Bougie);B：胃-回肠吻合（回肠距离回盲部260 cm,吻合口直径3 cm）;C：完成胃-回肠吻合;D：关闭Peterson裂孔;E：回肠-回肠吻合（距离胃-回肠吻合40 cm）;F：关闭系膜裂孔
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