细长胃囊在Roux-en-Y胃旁路手术中的应用与展望  

Application and prospect of long and narrow pouch in Roux-en-Y gastric bypass surgery

作　　者：黄晓[1] 胡嵩浩 董志勇[1] 王存川[1] 中国肥胖代谢外科研究协作组 HUANG Xiao;HU Songhao;DONG Zhiyong;WANG Cunchuan;Chinese Obesity and Metabolic Surgery(CollaborativeWeight Loss Center,The First Affiliated Hospital of Jinan University,Guangzhou 510630,P.R.China)

机构地区：[1]暨南大学附属第一医院减重中心,广州510630

出　　处：《中国普外基础与临床杂志》2024年第4期389-393,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：腹腔镜Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RYGB)是肥胖代谢外科的经典术式,它不仅减重效果明显,对2型糖尿病等代谢性疾病的治疗也疗效显著,但是术后可能会出现倾倒综合征、无饱腹感等问题。笔者团队在RYGB基础上进一步改良,采用细长胃囊RYGB(long and narrow pouch in RYGB,LN-RYGB),即通过改变胃小囊的长度,其长而窄的胃小囊更易长时间维持小体积且不易扩大,在一定程度上减慢食物通过,还可以降低反流、与RYGB有关的倾倒综合征及肠胆汁酸回流发生率,让胃内容物能充分混合,不仅产生更强烈的饱腹感,而且患者在术后反弹几率更小,还能降低与RYGB有关的溃疡并发症发生率,对于2型糖尿病的治疗效果也更好。今后可在临床实践中积累更多LN-RYGB病例的结果和数据,进一步证实其安全性及有效性;同时仍需注意,实施LN-RYGB仍有一定难度且没有明确的适应证。目前可遵循标准RYGB的适应证,需预防LN-RYGB术后营养不良及微量元素缺乏,做好长期随访准备。Laparoscopic Roux-en-Y gastric bypass(RYGB)is a classic operation in the field of obesity metabolicsurgery.It not only obviously reduces body weight but also exhibits notable therapeutic efficacy in treating metabolicdiseases such as type 2 diabetes.However,it can result in complications such as postoperative dumping syndrome and alack of satiety after meals.So our team has further modified the RYGB,introducing a long and narrow pouch in RYGB(LN-RYGB),its core is reserving the length of the gastric pouch,then the long and narrow pouch could make maintaininga small gastric volume for a prolonged period,make food pass through slowly,and reduce reflux and decrease theincidences of dumping syndrome and intestinal bile acid reflux relevant to RYGB.The gastric contents could be thoroughly mixed,not only leading to a stronger satiety after meals but also reducing risk of postoperative bounce back.Furthermore,ulcer complications relevant to RYGB markedly declined,the therapeutic outcome is better especially inpatients with type 2 diabetes.In future,more results and data relevant to LN-RYGB can be accumulated in clinic to furtherconfirm its safety and effectiveness.Mearnwhile,it should still be paid attended to that LN-RYGB still faccs certaindifficulties and has a clear indication.At present,the indications of RYGB are served as reference,and postoperativemalnutrition and element deficiency need to be prevented and a long-term follow-up is also necessary.

关 键 词：细长胃囊 ROUX-EN-Y胃旁路术 肥胖症 减重手术 

分 类 号：R656.61[医药卫生—外科学]