Abstract: The choice and difficulties of sleeve gastrectomy plus procedures        LIANG Hui, LI Cong, SHEN Jia-jia. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing210029, China
Corresponding author: LIANG Hui, E-mail: drhuiliang@126.com
Abstract    With the continuous development of bariatric and metabolic surgery, a variety of innovative procedures based on sleeve gastrectomy (SG) are emerging. Current clinical evidence indicates that sleeve-plus procedures not only enhance weight loss and hypoglycemic effect but also reduce surgical complications. Since there is no remnant stomach, gastroscopy can be easily performed after surgery. In the 1-year and 3-year follow-ups, the percentage of excess weight loss (%EWL) of sleeve gastrectomy with duodenojejunal bypass (SG-DJB) was 95.77% and 83.84%, and the percentage of total weight loss (%TWL) was 34.64% and 30.32%, respectively. The hypoglycemic effect of sleeve gastrectomy with proximal jejunal bypass (SG-PJB) and SG-DJB was similar to Roux-en-Y gastric bypass (RYGB), and the weight loss effect of SG-PJB was superior to SG alone. SG-DJB is recommended for alleviating type 2 diabetes. SG-PJB is preferred for patients whose primary objective is weight loss. RYGB surgery can be considered for patients with reflux esophagitis. SG plus surgery still needs high-quality research in the future.

Key words: sleeve gastrectomy, plus surgery, weight loss, diabetes mellitus, remission rate, complication

摘要： 随着减重代谢外科不断发展，以胃袖状切除术（SG）为基础的多种创新术式不断涌现。目前的临床证据表明，胃袖状切除术附加手术（SG plus）能增强减重降糖效果，减少手术并发症。由于没有旷置的胃囊，因此术后可以容易施行胃镜检查。 近期研究数据显示，胃袖状切除术联合十二指肠-空肠旁路术（SG-DJB）在1年和3年的随访中，多余体重减少百分比（%EWL）分别为95.77%和83.84%，总体重减少百分比（%TWL）分别为34.64%和30.32%，降糖效果和Roux-en-Y胃旁路术（RYGB）类似，胃袖状切除术联合近端空肠旁路术（SG-PJB）研究表明减重效果优于单纯的SG，减重降糖效果类似于RYGB，并发症远低于RYGB。治疗2型糖尿病为目的的手术推荐SG-DJB，对于以减重为主要目的的病人，优先选择SG-PJB，对于有合并反流性食管炎者可以考虑RYGB。SG plus未来仍然需要高质量的研究。

关键词: 胃袖状切除术, 附加手术, 减重, 糖尿病, 缓解率, 并发症