Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China.
Sci Rep. 2024 Mar 19;14(1):6522. doi: 10.1038/s41598-024-57289-3.
To evaluate the efficacy and nutrition of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in Chinese obese patients in the first postoperative year. Clinical data of 66 obese patients who underwent SADI-S surgery at China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were retrospectively collected. The weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) were recorded at 3, 6, and 12 months after surgery. Moreover, metabolic disease remission and nutrient deficiencies were assessed at 1 year postoperatively. Overall, 66 patients (38 males and 28 females) were recruited, with a mean age of 35 (18-61) years and an average preoperative BMI of 42.94 kg/m. Before surgery, 38 patients had type 2 diabetes mellitus (T2DM), 46 patients had hyperuricemia (HUA), 45 patients had hypertension (HTN), 35 patients had hyperlipidemia, 12 patients had hypercholesterolemia, 12 patients had hyper-low-density lipoproteinemia, and 14 patients had gastroesophageal reflux disease symptoms (GERD). All patients had undergone a DaVinci robotic or laparoscopic SADI-S surgery, and none converted to laparotomy or died. Four patients developed postoperative complications and were cured and discharged after conservative treatment or surgical treatment. At 3, 6 and 12 months, the average %EWL was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65%, %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89%, respectively. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), uric acid (UA), triglycerides (TG), blood pressure (BP), and other indexes were significantly lower after one year post-surgery compared with the preoperative period (P < 0.05). The remission rates of T2DM, HUA, HTN, hypertriglyceridemia, hypercholesterolemia, and hyper-low-density lipoproteinemia 1 year after surgery were 100, 65.2, 62.2, 94.3, 100, and100%, respectively. One year after surgery, the remission rate of GERD was 71.4% (10/14), the rate of new occurrence of GERD was 12.1% (8/66), and the overall incidence rate was 18.2% (12/66). Except for vitamin B12(vit B12), the other nutrient indexes were significantly decreased after 1 year of surgery relative to levels before surgery (P < 0.05). The deficiency rates for vitamin A (vit A), vitamin E (vit E), zinc ion (Zn), and folic acid (FA) were higher (45.5, 25.8, 24.2, and 16.7%, respectively); however, there were no related clinical symptoms. SADI-S had significant effects on weight loss and metabolic disease remission. The main nutrient deficiencies after SADI-S were vit A, vit E, Zn, and FA deficiencies. The long-term efficacy and safety of SADI-S warrant further follow-up.
评估单吻合口十二指肠空肠旁路袖状胃切除术（SADI-S）在中国肥胖患者术后第一年的疗效和营养情况。回顾性收集 2018 年 11 月至 2022 年 5 月在中国-日本联合医院接受 SADI-S 手术的 66 例肥胖患者的临床资料。记录术后 3、6 和 12 个月的体重、体质量指数（BMI）、超重减轻百分比（%EWL）和总体重减轻百分比（%TWL）。此外，术后 1 年评估代谢性疾病缓解和营养缺乏情况。总体而言，共纳入 66 例患者（38 例男性和 28 例女性），平均年龄 35（18-61）岁，术前 BMI 平均为 42.94 kg/m。术前有 38 例 2 型糖尿病（T2DM）、46 例高尿酸血症（HUA）、45 例高血压（HTN）、35 例高脂血症、12 例高胆固醇血症、12 例高低密度脂蛋白血症和 14 例胃食管反流病症状（GERD）。所有患者均行达芬奇机器人或腹腔镜 SADI-S 手术，无中转开腹或死亡。4 例患者术后发生并发症，经保守或手术治疗治愈出院。术后 3、6 和 12 个月，平均 %EWL 分别为 62.07±26.56、85.93±27.92 和 106.65±29.65%，%TWL 分别为 22.67±4.94、32.10±5.18 和 40.56±7.89%。与术前相比，术后 1 年空腹血糖（FBG）、糖化血红蛋白（HbA1c）、尿酸（UA）、甘油三酯（TG）、血压（BP）等指标明显降低（P<0.05）。术后 1 年 T2DM、HUA、HTN、高甘油三酯血症、高胆固醇血症和高低密度脂蛋白血症的缓解率分别为 100%、65.2%、62.2%、94.3%、100%和 100%。术后 1 年 GERD 缓解率为 71.4%（10/14），新发生 GERD 发生率为 12.1%（8/66），总发生率为 18.2%（12/66）。除维生素 B12（vit B12）外，术后 1 年其他营养指标与术前相比明显降低（P<0.05）。维生素 A（vit A）、维生素 E（vit E）、锌离子（Zn）和叶酸（FA）的缺乏率分别为 45.5%、25.8%、24.2%和 16.7%；但均无相关临床症状。SADI-S 对体重减轻和代谢性疾病缓解有显著效果。SADI-S 术后主要的营养缺乏是 vit A、vit E、Zn 和 FA 缺乏。SADI-S 的长期疗效和安全性尚需进一步随访。
