胆胰分流术（BPD）、胆胰分流术联合十二指肠转位术（BPD-DS）及袖状胃切除联合单吻合口十二指肠回肠旁路术（SADI-S）在肥胖患者中的长期效果：一项Meta分析。
Long-Term Effects of Biliopancreatic Diversion (BPD), Biliopancreatic Diversion with Duodenal Switch (BPD-DS), and Single Anastomosis Duodeno‑Ileal Bypass with Sleeve Gastrectomy (SADI‑S) in Patients with Obesity: A Meta-Analysis.
文献信息
| PMID | 42836947 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Shahriar Azizi |
| 作者单位 | Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. |
| 期刊 | Obesity surgery |
| SCI 分区 | Q1 |
| IF | 3.2 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 鼻科 |
中文摘要
引言： 胆胰分流术（BPD）、BPD联合十二指肠转位术（BPD-DS）以及袖状胃切除联合单吻合口十二指肠回肠旁路术（SADI-S）在肥胖患者中的长期结局尚未充分明确。
方法： 按照PRISMA指南，对PubMed、Embase、Scopus和Web of Science进行了系统检索，截止日期为2025年10月11日。纳入报告上述术式后≥10年结局的研究。
结果： 共纳入22项研究、2156例患者。BPD和BPD-DS与平均BMI降低19.02 kg/m²相关。BPD-DS实现总体重减轻（TWL）36.34%和超重体重减轻（EWL）75.22%。糖尿病、高血压、高脂血症和阻塞性睡眠呼吸暂停的缓解率分别为78%、63%、83%和89%。主要长期并发症包括修正手术（3%）、贫血（19%）、铁缺乏（34%）和骨骼疾病（25%）。与RYGB相比，BPD和BPD-DS实现更大的BMI降低（平均差6.31 kg/m²，95% CI：3.16，9.47）和更高的糖尿病缓解率（OR 3.49，95% CI：1.11，10.91），但胆囊切除术率更高。BPD和BPD-DS后糖尿病复发率为15%，空腹血糖和HbA1c显著降低。来自两项SADI-S研究的有限数据显示体重持续减轻（TWL 34.4%，EWL 80.4%），但因营养并发症导致的再手术率显著。
结论： 总体而言，BPD和BPD-DS可提供持久的体重减轻和代谢获益，但由于营养不良风险，仔细的患者选择和持续的多学科管理非常重要。SADI-S的长期数据似乎有前景但仍有限。
英文摘要
INTRODUCTION: The long-term outcomes of biliopancreatic diversion (BPD), BPD with duodenal switch (BPD-DS), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in patients with obesity are not well established.
METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted until October 11, 2025, following PRISMA guidelines. Studies reporting outcomes at ≥ 10 years following the specified procedures were included.
RESULTS: A total of 22 studies with 2156 patients were included. BPD and BPD-DS were associated with a mean BMI reduction of 19.02 kg/m². BPD-DS achieved total weight loss (TWL) of 36.34% and an excess weight loss (EWL) of 75.22%. Resolution rates for diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were 78%, 63%, 83%, and 89%, respectively. Major long-term complications included revision surgery (3%), anemia (19%), iron deficiency (34%), and bone disorders (25%). Compared with RYGB, BPD and BPD-DS achieved greater BMI reduction (mean difference 6.31 kg/m², 95% CI: 3.16, 9.47) and higher diabetes resolution (OR 3.49, 95% CI: 1.11, 10.91), but with a higher rate of cholecystectomy. Diabetes relapse after BPD and BPD-DS occurred in 15% of patients, with significant reductions in fasting blood sugar and HbA1c. Limited data from two studies on SADI-S showed sustained weight loss (TWL 34.4%, EWL 80.4%) but notable rates of reoperation due to nutritional complications.
CONCLUSION: Overall, BPD and BPD-DS provide lasting weight loss and metabolic benefits, but careful patient selection and ongoing multidisciplinary care are important because of the risk of malnutrition. Long-term data on SADI-S appear promising but remain limited.