腹腔镜胃袖状切除联合双通道术与腹腔镜胃袖状切除术治疗超级肥胖的近期疗效对比研究

doi:10.16139/j.1007-9610.2026.02.05

外科理论与实践 ›› 2026, Vol. 31 ›› Issue (02): 121-128.doi: 10.16139/j.1007-9610.2026.02.05

腹腔镜胃袖状切除联合双通道术与腹腔镜胃袖状切除术治疗超级肥胖的近期疗效对比研究

朱玉喜¹^,², 倪良晨¹^,², 王键¹^,², 洪健¹^,², 朱孝成¹^,²(), 姚立彬¹^,²()

¹ 徐州医科大学附属医院减重代谢外科，江苏徐州 221006
² 徐州医科大学国际肥胖及代谢病中心，江苏徐州 221004

收稿日期:2025-05-05 出版日期:2026-04-25 发布日期:2026-06-23
通讯作者: 姚立彬，E-mail: yaolibin_123@126.com; 朱孝成，E-mail: zhuxccf@163.com
作者简介:作者贡献/Authors’ contributions
朱玉喜、倪良晨、王键负责资料的收集、数据分析和撰写；王键、洪健负责整理数据和汇总；朱孝成、姚立彬负责指导、审查和修订。所有作者均阅读并确认最终稿。
基金资助:
江苏省高水平医院建设项目徐州医科大学附属医院高水平医院建设专项(GSPJS202405);徐州医科大学附属医院高层次科研项目培育计划（重点项目）(PYJH2025202)

Short-term efficacy of laparoscopic sleeve gastrectomy with transit bipartition versus laparoscopic sleeve gastrectomy in the treatment of super obesity

ZHU Yuxi¹^,², NI Liangchen¹^,², WANG Jian¹^,², HONG Jian¹^,², ZHU Xiaocheng¹^,²(), YAO Libin¹^,²()

¹ Department of Bariatric and Metabolic Surgery, the Affiliated Hospital of Xuzhou Medical University, Jiangsu Xuzhou 221006, China
² International Center for Obesity and Metabolic Diseases, Xuzhou Medical University, Jiangsu Xuzhou 221004, China

Received:2025-05-05 Online:2026-04-25 Published:2026-06-23

摘要/Abstract

摘要：

目的：比较腹腔镜胃袖状切除联合双通道术（LSG-TB）与腹腔镜胃袖状切除术（LSG）治疗超级肥胖病人的近期疗效及安全性。方法：回顾分析113例超级肥胖病人（LSG组75例，LSG-TB组38例）术后12个月的减重、代谢改善、营养变化及并发症发生情况。结果：LSG-TB组术后12个月总体重减少百分比(TWL%)和多余体重减少百分比(EWL%)显著高于LSG组（40.0%比36.6%，73.4%比66.2%，P<0.05）。两组血糖控制相当，但LSG-TB组总胆固醇(TC)、低密度脂蛋白(LDL)及尿酸(UA)下降更明显（P<0.05）。胃食管反流病(GERD)缓解率在LSG-TB组亦更高（P<0.05）。两组术后并发症发生率低，营养指标整体稳定。结论：LSG-TB在超级肥胖病人中展现出更优的近期减重与代谢改善效果，且安全性良好，与LSG相当，具有一定的临床应用价值。

关键词: 超级肥胖, 腹腔镜胃袖状切除术, 双通道术, 减重手术, 代谢改善

Abstract:

Objective To compare the short-term efficacy and safety of laparoscopic sleeve gastrectomy (LSG) with transit bipartition (TB) versus LSG in super obese patients. Methods A retrospective study was conducted on 113 super obese patients (LSG 75, LSG-TB 38 cases), evaluating weight loss, metabolic outcomes, nutritional indicators, and complications over 12 months. Results At 12 months, LSG-TB showed significantly higher percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL) than LSG (40.0% vs. 36.6%, 73.4% vs. 66.2%, P<0.05). Both groups achieved similar glycemic control, while total cholesterol (TC), low density lipoprotein (LDL), and uric acid (UA) levels decreased more in the LSG-TB group (P<0.05). Gastroesophageal reflux disease (GERD) remission was significantly better with LSG-TB (P<0.05). Postoperative complication rates were low in both groups, with stable nutritional status. Conclusions LSG-TB demonstrates superior short-term weight loss and metabolic benefits in super obese patients, with comparable safety to LSG, supporting its clinical value.

Key words: Super obesity, Laparoscopic sleeve gastrectomy (LSG), Transit bipartition(TB), Bariatric surgery, Metabolic benefit

中图分类号:

朱玉喜, 倪良晨, 王键, 洪健, 朱孝成, 姚立彬. 腹腔镜胃袖状切除联合双通道术与腹腔镜胃袖状切除术治疗超级肥胖的近期疗效对比研究[J]. 外科理论与实践, 2026, 31(02): 121-128.

ZHU Yuxi, NI Liangchen, WANG Jian, HONG Jian, ZHU Xiaocheng, YAO Libin. Short-term efficacy of laparoscopic sleeve gastrectomy with transit bipartition versus laparoscopic sleeve gastrectomy in the treatment of super obesity[J]. Journal of Surgery Concepts & Practice, 2026, 31(02): 121-128.

图/表 7

图1

表1

表2

图2

表3

血糖、UA及脂代谢指标($\bar{x}\pm s$)

Variable	LSG	LSG-TB	t/P value^a)	t/P value^b)	t/P value^c)
Baseline
FBG（mmol/L）	6.2±2.2	6.6±1.9	-	-	-0.989/0.325
TG（mmol/L）	1.8±0.9	2.0±1.1	-	-	-1.089/0.279
TC（mmol/L）	4.7±1.0	4.7±1.2	-	-	-0.275/0.784
UA（μmol/L）	452.9±107.8	424.1±106.0	-	-	1.322/0.189
HDL（mmol/L）	1.0±0.2	1.0±0.2	-	-	-1.051/0.298
LDL（mmol/L）	2.9±0.9	3.0±0.6	-	-	-0.695/0.490
HbA1c（%）	6.4±1.4	6.8±1.4	-	-	-1.396/0.166
1 month
FBG（mmol/L）	5.5±0.9	5.8±0.8	-2.121/0.040	-1.168/0.262	-1.017/0.313
TG（mmol/L）	1.5±0.4	1.8±0.7	-2.439/0.020	-1.572/0.136	-2.015/0.048
TC（mmol/L）	4.4±0.8	4.7±1.0	-2.383/0.022	-0.814/0.427	-1.060/0.293
UA（μmol/L）	496.0±110.8	428.8±86.3	1.634/0.112	-1.397/0.182	2.252/0.029
HDL（mmol/L）	1.1±0.5	1.0±0.2	1.172/0.260	-1.735/0.103	1.003/0.323
LDL（mmol/L）	2.6±0.9	3.0±0.8	-1.983/0.065	-0.728/0.478	-1.279/0.210
HbA1c（%）	5.8±0.6	5.8±0.7	-3.803/0.001	-4.335/0.007	-0.007/0.994
6 months
FBG（mmol/L）	5.1±0.6	5.0±0.5	-4.040/<0.001	-1.529/0.152	0.465/0.644
TG（mmol/L）	1.1±0.4	1.2±0.5	-3.404/0.002	-2.757/0.017	-0.151/0.880
TC（mmol/L）	4.5±0.9	4.0±0.6	-0.874/0.391	-1.051/0.314	1.738/0.091
UA（μmol/L）	378.5±91.1	373.4±63.0	-1.972/0.061	-3.998/0.002	1.171/0.866
HDL（mmol/L）	1.0±0.1	1.0±0.2	0.752/0.471	0.462/0.655	-0.003/0.997
LDL（mmol/L）	2.5±0.9	2.4±0.6	-1.361/0.207	-1.169/0.276	0.287/0.776
HbA1c（%）	5.3±0.2	5.1±0.3	-2.904/0.017	-2.730/0.052	1.420/0.179
12 months
FBG（mmol/L）	4.9±0.5	4.9±0.5	-3.212/0.003	-5.328/<0.001	0.616/0.540
TG（mmol/L）	0.9±0.4	1.0±0.4	-5.447/<0.001	-4.159/<0.001	-0.570/0.572
TC（mmol/L）	4.6±0.7	3.6±0.7	-.950/0.351	-2.932/0.008	4.565/<0.001
UA（μmol/L）	377.1±76.5	310.5±74.3	-3.319/0.005	-4.123/<0.001	2.558/0.015
HDL（mmol/L）	1.2±0.2	1.2±0.3	3.552/0.004	2.181/0.043	0.848/0.402
LDL（mmol/L）	2.7±0.9	2.0±0.5	-1.397/0.188	-5.713/<0.001	2.907/0.006
HbA1c（%）	5.1±0.4	4.8±0.6	-2.646/0.023	-6.059/0.004	1.087/0.294

表3

图3

表4

参考文献 29

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Variable	LSG （n=75）	LSG-TB （n=38）	t/χ² value	P value
Age (year)	30.2±8.1	31.2±5.1	t=-0.705	0.483
Gender(male/female)	28（37.3）/47（62.7）	11（28.9）/27（71.1）	χ²=0.785	0.376
BMI（kg/m²）	54.2±4.5	53.1±3.5	t=1.330	0.186
T2DM	27（36.0）	20（52.6）	χ²=2.872	0.090
Hypertension	25（33.3）	18（47.4）	χ²=2.108	0.147
GERD	9（12.0）	6（15.8）	χ²=0.315	0.575

Variable	LSG （n=75）	LSG-TB （n=38）	t value	P value
Operative time (min)	101.9±21.1	143.0±19.5	-8.721	<0.001
Postoperative hospital stay (d)	2.6±0.9	2.7±0.9	-1.117	0.907
Perioperative complications	1（1.3）	1（2.6）	-	>0.999

Variable	LSG	LSG-TB	χ² value	P value
T2DM remission	22/27（81.5）	18/20（90.0）	-	0.682
Hypertension remission	23/25（92.0）	17/18（94.4）	-	>0.999
GERD remission	2/9（22.2）	5/6（83.3）	-	0.041
Constipation	16/75（21.3）	1/38(2.6)	-	0.01
Diarrhea	4/75（5.3）	9/38（23.7）	6.637	0.01
Malodorous flatus	27/75（32.0）	20/38（52.6）	2.872	0.09

腹腔镜胃袖状切除联合双通道术与腹腔镜胃袖状切除术治疗超级肥胖的近期疗效对比研究

Short-term efficacy of laparoscopic sleeve gastrectomy with transit bipartition versus laparoscopic sleeve gastrectomy in the treatment of super obesity

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