袖状胃切除术是治疗重度肥胖有效的手段之一，然而术后远期体重恢复，严重影响了该技术的临床获益。体重恢复不是由单个原因导致，而是在能量负平衡状态下的多种系统的协同性防御结果。本文首先对袖状胃切除术后体重恢复的流行病学和定义进行梳理，在此基础上详细介绍了袖状胃切除后体重恢复背后的生物学机制：脂肪细胞、免疫细胞的"代谢记忆"，构成了组织层面的易感基础；肠道菌群—肠—脑轴的重塑参与能量吸收以及食欲中枢的再编程；瘦体重丢失及其带来的代谢适应，从能耗和食欲两个方面驱动体重回升；下丘脑食欲调控网络的结构和功能改变则形成了持续摄食增加的神经基础。这些机制之间互相联系并最终促使能量平衡向着正的方向偏移。在此基础上提出了一个"生活方式强化到药物干预再到内镜与修正手术"的三阶梯管理策略，并重点综述了GLP-1受体激动剂及修正手术在袖状胃切除后体重恢复中的应用证据和疗效差异。本综述意在给临床医生提供一个从机制认识到分层干预的整合框架，帮助减重外科走向长期慢病管理的模式转变。

Sleeve gastrectomy is one of the effective interventions for severe obesity; however, long-term weight regain after surgery substantially compromises its clinical benefits. Weight regain is not attributable to a single cause, but rather represents a coordinated defensive response across multiple systems under a state of negative energy balance. This review first outlines the epidemiology and definition of weight regain following sleeve gastrectomy. On this basis, we elaborate on the underlying biological mechanisms, including the "metabolic memory" of adipocytes and immune cells, which constitutes the tissue-level susceptibility basis; the remodeling of the gut microbiota-gut-brain axis, which participates in energy absorption and reprogramming of appetite centers; the loss of lean body mass and associated metabolic adaptation, which drive weight rebound through both energy expenditure and appetite regulation; and the structural and functional alterations in hypothalamic appetite-regulatory networks, which form the neural foundation for sustained increases in food intake. These mechanisms are interconnected and collectively shift energy balance toward a positive direction. Furthermore, we propose a three-tiered stepwise management strategy-"lifestyle intensification-pharmacological intervention-endoscopic and revisional surgery"-with a focused review of the evidence and differential efficacy of GLP-1 receptor agonists and revisional surgery in managing weight regain after sleeve gastrectomy. This review aims to provide clinicians with an integrated framework spanning mechanistic understanding to stratified intervention, facilitating the transition of bariatric surgery toward a long-term chronic disease management model.