袖状胃切除术中胃的切除范围与患者预后
Gastric Resection Extent in Sleeve Gastrectomy and Patient Outcomes
摘要: 目的：系统回顾腹腔镜袖状胃切除术中胃切除范围与患者预后的关系，为临床实践提供循证依据。方法：综合分析距幽门切除起始点距离(DFP)及胃支撑管尺寸对术后减重效果、代谢改善、并发症发生率的影响。结果：激进切除(DFP ≤ 3 cm)可提升早期减重效果及糖尿病缓解率，术后1年超重减轻百分比(%EWL)较保守切除组高8.3% (P < 0.001)，但5年体重反弹风险增加(18% vs 9%)，新发胃食管反流病(GERD)发生率升高2.1~3.4倍。保守切除(DFP > 5 cm)虽早期减重较缓，但利于长期生活质量维持及反流控制。胃管尺寸方面，32~36 Fr可平衡减重效果与吻合口漏风险(漏发生率0.92% vs 2.67%)。术后脱水风险以胃管 < 36 Fr联合DFP ≥ 4 cm组合最低。结论：DFP 3~5 cm结合适中胃底切除为多数患者的最优方案，可平衡减重(%EWL > 60%)、共病缓解及并发症控制。临床决策需基于患者年龄、BMI、反流史等因素个体化制定。
Abstract: Objective: This paper aims to systematically review the relationship between gastric resection extent in laparoscopic sleeve gastrectomy (LSG) and patient outcomes, providing evidence-based guidance for clinical practice. Methods: A comprehensive analysis was conducted on the impact of distance from pylorus (DFP) and bougie size on postoperative weight loss, metabolic improvement, and complication rates. Results: Aggressive resection (DFP ≤ 3 cm) enhanced early weight loss and diabetes remission, with 1-year percentage of excess weight loss (%EWL) 8.3% higher than conservative resection (P < 0.001), but increased 5-year weight regain risk (18% vs 9%) and de novo gastroesophageal reflux disease (GERD) incidence by 2.1~3.4 folds. Conservative resection (DFP > 5 cm), though achieving slower early weight loss, favored long-term quality of life and reflux control. Regarding bougie size, 32~36 Fr balanced weight loss efficacy with staple line leak risk (leak rate 0.92% vs 2.67%). Postoperative dehydration risk was minimized with bougie < 36 Fr combined with DFP ≥ 4 cm. Conclusion: DFP of 3~5 cm with moderate fundal resection represents the optimal approach for most patients, balancing weight loss (%EWL > 60%), comorbidity resolution, and complication control. Clinical decision-making should be individualized based on patient age, BMI, reflux history, and other factors.
文章引用：杨凯政, 曾梦华. 袖状胃切除术中胃的切除范围与患者预后[J]. 临床医学进展, 2026, 16(1): 1818-1825. https://doi.org/10.12677/acm.2026.161231

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