单吻合口十二指肠转流术改良术：对当前结局相关文献的综述。
The single anastomosis duodenal switch modifications: a review of the current literature on outcomes.
机构信息
Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.
Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.
出版信息
Surg Obes Relat Dis. 2017 Aug;13(8):1306-1312. doi: 10.1016/j.soard.2017.04.027. Epub 2017 Apr 27.
BACKGROUND
The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was designed in 2007 to reduce the side effects of biliopancreatic diversion with duodenal switch (BPD-DS) by replacing the Roux-en-Y construction with a single duodeno-ileal anastomosis and combining the common channel with the alimentary limb. Several variants using different channel lengths were published. The objective of this study was to identify the published cases of SADI-S and variants and assess the results regarding potential benefits on side effects and revisions.
METHODS
PubMed, ClinicalTrials.gov, and the databases of 3 relevant surgical journals were searched for any publication from 2007 to date.
RESULTS
In all, 19 studies were analyzed. After identifying overlaps, 1,041 patients among 9 institutions were identified: 304 with SADI-S, 667 with stomach intestinal pylorus sparing surgery, and 70 with single anastomosis duodenojejunal bypass with sleeve gastrectomy. There were no postoperative deaths and the early complication rate was 7.3% (range 1.6-14%). The mean operative time was 100.8 minutes (range 69.9-181.7 min). The mean 1-year percentage of excess weight loss (%EWL) was 78.7% (range 61.6-87%) and percentage of total weight loss (%TWL) was 36.8% (range 32.7-41.1%). Two studies reported a 2-year %TWL of 38.7% and a single study reported a 5-year %TWL of 37%. A total of 50% of patients had biological data at 1 year. One retrospective study found no difference between BPD-DS and SIPS for vitamin deficiency at 2 years, but there was less severe diarrhea and malnutrition after SIPS. The revision rate increased from 2% to 7% after SADI-S between 2- and 5-year follow-up.
CONCLUSION
There are still limited long-term data available for single anastomosis duodenal switch. In the absence of published prospective randomized trials, no evidence exists in favor of this variant of the BPD-DS despite a possible trend in less malabsorption side effects.
背景
单吻合口十二指肠空肠旁路加袖状胃切除术（SADI-S）于 2007 年设计，旨在通过用单吻合口十二指肠空肠吻合术代替 Roux-en-Y 术式，并将共同通道与食物支结合，来减少胆胰分流与十二指肠转位术（BPD-DS）的副作用。已经发表了几种使用不同通道长度的变体。本研究的目的是确定 SADI-S 和变体的已发表病例，并评估其在副作用和修订方面的潜在获益。
方法
在 2007 年至今的时间范围内，对 PubMed、ClinicalTrials.gov 以及 3 种相关外科期刊的数据库进行了检索，以查找任何出版物。
结果
共分析了 19 项研究。在确定重叠部分后，从 9 个机构中确定了 1041 例患者：304 例 SADI-S，667 例胃保留空肠旁路术，70 例单吻合口十二指肠空肠旁路加袖状胃切除术。术后无死亡，早期并发症发生率为 7.3%（1.6%-14%）。平均手术时间为 100.8 分钟（69.9-181.7 分钟）。1 年时的平均超重减轻率（%EWL）为 78.7%（61.6%-87%），总体重减轻率（%TWL）为 36.8%（32.7%-41.1%）。两项研究报告了 2 年时的%TWL 为 38.7%，一项研究报告了 5 年时的%TWL 为 37%。有 50%的患者在 1 年时有生物学数据。一项回顾性研究发现，2 年时 SIPS 在维生素缺乏方面与 BPD-DS 无差异，但 SIPS 后腹泻和营养不良较轻。SADI-S 后，2 年至 5 年随访时，修复率从 2%增加到 7%。
结论
单吻合口十二指肠转位术的长期数据仍然有限。在没有前瞻性随机试验的情况下，尽管 BPD-DS 的这种变体可能存在吸收不良副作用减少的趋势，但没有证据支持这种变体。
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