单吻合口袖状胃空肠吻合术与单吻合口胃旁路术治疗肥胖症的临床疗效分析

doi:10.3877/cma.j.issn.2095-9605.2025.04.003

目的

比较单吻合口袖状胃空肠吻合术（SASJ）和单吻合口胃旁路术（OAGB）治疗肥胖症的临床疗效。

方法

结果

回顾性收集2023年1月至2024年1月于南京大学医学院附属鼓楼医院减重代谢外科行SASJ和OAGB的患者临床资料，共纳入152例患者，根据接受的手术方式分为SASJ组（82例）和OAGB组（70例）。主要指标包括患者术前、术后6个月至12个月的体重、BMI、糖脂代谢指标等，并记录合并症的缓解情况。通过卡方检验和独立样本t检验对数据进行统计分析。回顾性收集2023年1月至2024年1月于南京大学医学院附属鼓楼医院减重代谢外科行SASJ和OAGB的患者临床资料，共纳入152例患者，根据接受的手术方式分为SASJ组（82例）和OAGB组（70例）。主要指标包括患者术前、术后6个月至12个月的体重、BMI、糖脂代谢指标等，并记录合并症的缓解情况。通过卡方检验和独立样本t检验对数据进行统计分析。

结论

SASJ和OAGB在体重减轻和缓解并发症方面疗效相近，而SASJ术后营养不良的风险低于OAGB，且SASJ术后发生吻合口溃疡的概率更低。

关键词: 肥胖症, 减重手术, 单吻合口胃空肠吻合术, 单吻合口胃旁路术

Objective

To compare the clinical efficacy of Single-Anastomosis Sleeve Jejunal Bypass (SASJ) and One-Anastomosis Gastric Bypass (OAGB) for the treatment of obesity.

Methods

Retrospective clinical data were collected from patients who underwent SASJ and OAGB from January 2023 to January 2024 at the Department of Weight Loss and Metabolic Surgery, Drum Tower Hospital, School of Medicine, Nanjing University, China, and the main indexes included the patients' preoperative and postoperative weights, BMI, and glycemic-lipid metabolism indexes from 6 to 12 months after surgery, and the remission of comorbidities was also recorded. The data were statistically analyzed using chi-square test and independent sample t-test.

Results

Total 152 patients were included in this study and were categorized into SASJ group (n=82) and OAGB group (n=70) according to the type of surgery they underwent. Significant weight loss as well as remission of complications were recorded at 6 and 12 months after both procedures. The weights at 6 and 12 months postoperatively were (93.1±15.7) kg and (84.2±16.6) kg in the SASJ group and (94.1±26.2) kg and (85.3±22.7) kg in the OAGB group, respectively.The remission rates for T2DM were 91.7% in the SASJ group and 91.7% in the OAGB group. and OAGB showed remission rates of 91.7% and 90% for T2DM and 81.3% and 80% for GERD, respectively. In addition, a relatively high risk of postoperative malnutrition in OAGB was documented at 12 months postoperatively. This was manifested by low postoperative nutritional markers such as albumin, serum calcium, and 25 hydroxyvitamin D, which were still within the normal range. Postoperative gastroscopic findings revealed anastomotic ulcers in 6 patients after OAGB, whereas SASJ had fewer abnormal postoperative gastroscopic findings, with only 1 anastomotic ulcer as well as 2 cases of reflux esophagitis.

Conclusions

SASJ and OAGB have similar efficacy in weight loss and relief of complications, while the risk of malnutrition after SASJ is lower than that after OAGB, and the probability of anastomotic ulcer after SASJ is lower.

Key words: Obesity, Bariatric surgery, Single-Anastomosis Sleeve Jejunal, One-Anastomosis Gastric Bypass

图1 手术方式示意图

表1 两组患者术前一般特征

变量	SASJ（n=82）	OAGB（n=70）	P值
男/女	42/40	29/41	0.521
年龄（岁）	34.59±7.8	34.5±5.2	0.632
体重（kg）	102.5±12	106.3±19.5	0.131
BMI（kg/m²）	39.2±5.1	40.7±4.2	0.375
2型糖尿病（%）	36（43.9）	30（42.9）	0.665
高血压（%）	23(28)	22(31.4)	0.052
高脂血症（%）	36(43.9)	32(45.7)	0.301
睡眠呼吸暂停综合征（%）	5(6)	8(11.4)	0.031
胃食管反流病（%）	16(19.5)	10(14.3)	0.381

表1 两组患者术前一般特征

变量	SASJ（n=82）	OAGB（n=70）	P值
男/女	42/40	29/41	0.521
年龄（岁）	34.59±7.8	34.5±5.2	0.632
体重（kg）	102.5±12	106.3±19.5	0.131
BMI（kg/m²）	39.2±5.1	40.7±4.2	0.375
2型糖尿病（%）	36（43.9）	30（42.9）	0.665
高血压（%）	23(28)	22(31.4)	0.052
高脂血症（%）	36(43.9)	32(45.7)	0.301
睡眠呼吸暂停综合征（%）	5(6)	8(11.4)	0.031
胃食管反流病（%）	16(19.5)	10(14.3)	0.381

表2 两组患者术后体重变化

变量		SASJ（n=82）	OAGB（n=70）	P值
体重（kg）	术后6m	93.1±15.7	94.1±26.2	0.193
	术后12m	84.2±16.6	85.3±22.7	0.181
	P值	<0.001	0.003
BMI (kg/m²)	术后6m	35.1±6.9	36.1±4.2	0.053
	术后12m	32.4±4.8	31.2±5.4	0.084
	P值	<0.001	0.002
%TWL	术后6m	21.6±4.3	21.2±5.3	0.032
	术后12m	27.5±5.2	27.9±5.1	0.718
	P值	<0.001	<0.001
%EWL	术后6m	59.7±23.7	58.9±19.1	0.134
	术后12m	74.9±21.3	72.8±19.7	0.001
	P值	<0.001	<0.001
%EBMIL	术后6m	59.2±21.9	58.5±25.5	0.162
	术后12m	75.2±22.6	74.8±18.7	0.417
	P值	<0.001	0.001

表2 两组患者术后体重变化

变量		SASJ（n=82）	OAGB（n=70）	P值
体重（kg）	术后6m	93.1±15.7	94.1±26.2	0.193
	术后12m	84.2±16.6	85.3±22.7	0.181
	P值	<0.001	0.003
BMI (kg/m²)	术后6m	35.1±6.9	36.1±4.2	0.053
	术后12m	32.4±4.8	31.2±5.4	0.084
	P值	<0.001	0.002
%TWL	术后6m	21.6±4.3	21.2±5.3	0.032
	术后12m	27.5±5.2	27.9±5.1	0.718
	P值	<0.001	<0.001
%EWL	术后6m	59.7±23.7	58.9±19.1	0.134
	术后12m	74.9±21.3	72.8±19.7	0.001
	P值	<0.001	<0.001
%EBMIL	术后6m	59.2±21.9	58.5±25.5	0.162
	术后12m	75.2±22.6	74.8±18.7	0.417
	P值	<0.001	0.001

表3 两组患者术后并发症缓解情况

并发症	SASJ（n=82）	OAGB（n=70）	P值
2型糖尿病（%）	33/36(91.7)	27/30(90)	0.638
高血压（%）	21/23(91.3)	20/22(91)	0.681
高脂血症（%）	34/36(94.4)	30/32(93.8)	0.569
胃食管反流病（%）	13/16(81.3)	8/10(80)	0.773
睡眠呼吸暂停综合征（%）	5/5(100)	8/8(100)	0.99

表3 两组患者术后并发症缓解情况

并发症	SASJ（n=82）	OAGB（n=70）	P值
2型糖尿病（%）	33/36(91.7)	27/30(90)	0.638
高血压（%）	21/23(91.3)	20/22(91)	0.681
高脂血症（%）	34/36(94.4)	30/32(93.8)	0.569
胃食管反流病（%）	13/16(81.3)	8/10(80)	0.773
睡眠呼吸暂停综合征（%）	5/5(100)	8/8(100)	0.99

表4 两组患者术后12个月营养指标

变量		SASJ（n=82）	OAGB（n=70）	P值
白蛋白（g/L）	术前	42.5±4.3	42.9±3.1	0.421
白蛋白（g/L）	术后12m	32.5±3.6	31.4±2.6	0.371
血清钙（mmol/l）	术前	2.3±0.3	2.3±0.7	0.871
血清钙（mmol/l）	术后12m	2.2±0.5	2.1±0.1	0.352
25羟基维生素D（ng/ml）	术前	61.7±15.9	62.7±12.8	0.271
25羟基维生素D（ng/ml）	术后12m	59.9±12.6	57.5±11.4	0.001^*
维生素B₁₂（pg/ml）	术前	612.2±126.3	587±143	0.152
维生素B₁₂（pg/ml）	术后12m	582±117.3	528.5±131.1	0.001^*

表4 两组患者术后12个月营养指标

变量		SASJ（n=82）	OAGB（n=70）	P值
白蛋白（g/L）	术前	42.5±4.3	42.9±3.1	0.421
白蛋白（g/L）	术后12m	32.5±3.6	31.4±2.6	0.371
血清钙（mmol/l）	术前	2.3±0.3	2.3±0.7	0.871
血清钙（mmol/l）	术后12m	2.2±0.5	2.1±0.1	0.352
25羟基维生素D（ng/ml）	术前	61.7±15.9	62.7±12.8	0.271
25羟基维生素D（ng/ml）	术后12m	59.9±12.6	57.5±11.4	0.001^*
维生素B₁₂（pg/ml）	术前	612.2±126.3	587±143	0.152
维生素B₁₂（pg/ml）	术后12m	582±117.3	528.5±131.1	0.001^*

表5 两组患者术后12月胃镜结果

指标	SASJ（n=82）	OAGB（n=70）	P值
反流性食管炎（A级）	2	0	0.001
慢性浅表性胃炎伴糜烂	7	6	0.659
吻合口溃疡	1	8	0.001

表5 两组患者术后12月胃镜结果

指标	SASJ（n=82）	OAGB（n=70）	P值
反流性食管炎（A级）	2	0	0.001
慢性浅表性胃炎伴糜烂	7	6	0.659
吻合口溃疡	1	8	0.001

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Analysis of clinical efficacy of single-anastomosis sleeve jejunal bypass and one-anastomosis gastric bypass in the treatment of obesity

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Analysis of clinical efficacy of single-anastomosis sleeve jejunal bypass and one-anastomosis gastric bypass in the treatment of obesity