背景:一种吻合胃旁路术(OAGB)被认为是代谢手术中的标准程序。然而,对术后胆汁反流和营养风险的担忧很普遍.相对而言,袖状胃切除术伴环状十二指肠空肠旁路术(SG+LoopDJB)在维持幽门功能的同时,绕过与OAGB相当的前肠长度。关于这些代谢程序的治疗结果和副作用,幽门功能的作用仍有待进一步阐明。
方法:在我们中心进行了一项回顾性研究,以比较OAGB和SG+LoopDJB在2型糖尿病(T2DM)缓解方面的手术安全性和1年结局。减肥,胃肠道疾病,2型糖尿病患者的营养状况与性别相匹配,年龄,BMI。
结果:组间基线特征相当。与OAGB相比,SGLoopDJB的手术时间和住院时间(LOS)更长,但术后主要并发症相似。在1年的随访中,OAGB的糖尿病缓解率相似(均为91.9%),减肥效果(28.1±7.1%vs.%TWL为30.2±7.0%),SG+LoopDJB对血脂的改善(P>0.05)。然而,OAGB的低白蛋白血症发生率较高(11.9%vs.2.4%,P=0.026),但胃食管反流病(GERD)症状的发生率较低(9.5%vs.26.2%,P=0.046)比SG+LoopDJB。关于其他胃肠道疾病和营养缺乏,组间没有统计学差异。
结论:OAGB和SG+LoopDJB均具有可比性,减肥的有利结果,T2DM缓解期,1年随访时血脂改善。幽门保存,虽然增加了手术难度和新发GERD的风险,可降低术后低蛋白血症的风险。
BACKGROUND: One anastomosis gastric bypass (OAGB) is recognized as a standard procedure in metabolic surgery. However, concerns about postoperative bile reflux and nutritional risks are prevalent. Comparatively, sleeve gastrectomy with loop duodenojejunal bypass (SG + LoopDJB) bypasses an equivalent length of the foregut as OAGB while maintaining pyloric function. The role of pylorus function remains to be further elucidated regarding these metabolic procedures\' therapeutic outcomes and side effects.
METHODS: A retrospective study was conducted in our center to compare the surgical safety and 1-year outcomes of OAGB and SG + LoopDJB regarding type 2 diabetes mellitus (T2DM) remission, weight loss, gastrointestinal disorders, and nutritional status in T2DM patients matched by gender, age, and BMI.
RESULTS: The baseline characteristics were comparable between groups. Compared with OAGB, SG + LoopDJB had longer operative time and length of stay (LOS) but similar major postoperative complications. At 1-year follow-up, OAGB has similar diabetes remission (both 91.9%), weight loss effect (28.1 ± 7.1% vs. 30.2 ± 7.0% for %TWL), and lipidemia improvement to SG + LoopDJB (P > 0.05). However, OAGB presented a higher incidence of hypoalbuminemia (11.9% vs. 2.4%, P = 0.026) but a low incidence of gastroesophageal reflux disease (GERD) symptoms (9.5% vs. 26.2%, P = 0.046) than SG + LoopDJB. There was no statistical difference regarding other gastrointestinal disorders and nutritional deficiencies between groups.
CONCLUSIONS: Both OAGB and SG + LoopDJB show comparable, favorable outcomes in weight loss, T2DM remission, and lipidemia improvement at the 1-year follow-up. Pylorus preservation, while increasing surgical difficulty and the risk of de novo GERD, may reduce the risk of postoperative hypoalbuminemia.