单吻合口十二指肠-回肠旁路术联合袖状胃切除术（SADI-S）与Roux-en-Y胃旁路术（RYGB）在体重减轻、相关医学问题缓解及并发症方面的比较：一项系统评价与Meta分析
Comparison Between Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-En-Y Gastric Bypass (RYGB) in Terms of Weight Loss, Associated Medical Problems Remission, and Complications: A Systematic Review with Meta-Analysis.
作者信息
Sabatella Lucas, Aliseda Jover Daniel, M Ortega Patricia, Landecho Acha Manuel Fortún, Rotellar Sastre Fernando, Tuero Ojanguren Carlota, Blanco Asensio Nuria, Uriz Pagola Adriana, Valentí Azcárate Victor
机构信息
Clínica Universidad de Navarra, Pamplona, Spain.
Imperial College Healthcare NHS Trust, London, United Kingdom.
出版信息
Obes Surg. 2025 Jul 22. doi: 10.1007/s11695-025-08092-0.
BACKGROUND
Evaluate and compare the results of weight loss outcomes, associated medical problems resolution, and complications in the short and long term between SADI-S and RYGB.
METHODS
A systematic review was conducted following PRISMA guidelines. Studies comparing SADI-S and RYGB as primary surgery were included if they reported weight loss (total weight loss (TWL), excess weight loss (EWL), or body mass index (BMI) changes), associated medical problems remission (diabetes and hypertension), and postoperative outcomes (complications, hospital stay, and operative time). A meta-analysis of mean differences (MD) was conducted to assess continuous outcomes, and a meta-analysis of odds ratios (OR) was performed to evaluate the categorical variables; a random effects model was used.
RESULTS
Eight studies, including 4259 patients (1625 SADI-S; 2634 RYGB), were analysed. Six studies with over 2 years of follow-up (mean 3.93 years (1.79)) were included for long-term outcomes, while all eight were considered for short-term outcomes. SADI-S resulted in a statistically significant higher total weight loss (MD 10.03; 95% CI 4.7-15.35; p < 0.001), excess weight loss (MD 10.15; 95% CI 5.2-15.1; p < 0.01), diabetes remission (OR 3.48; 95% CI 2.02-6.02; p < 0.001) with a similar number of long-term complications (OR = 0.19, 95% CI 0.03-1.36; p = 0.10). Short-term complications were inferior in the subgroup of patients undergoing SADI-S with < 50 kg/m of BMI (OR 0.45, 95% CI 0.33 to 0.61; p < 0.01) as well as hospital stay (MD = -0.69; 95% CI -1.03 to -0.36, p < 0.01) and severe complications (OR = 0.44, 95% CI 0.25-0.80; p = 0.01).
CONCLUSIONS
This meta-analysis suggests that SADI-S may offer advantages over RYGB in terms of weight loss, diabetes remission, and safety profile.
背景
评估并比较单吻合口十二指肠回肠旁路术（SADI-S）和胃旁路术（RYGB）在短期和长期的体重减轻效果、相关医学问题的解决情况及并发症。
方法
按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。纳入比较SADI-S和RYGB作为初次手术的研究，这些研究需报告体重减轻情况（总体重减轻（TWL）、超重减轻（EWL）或体重指数（BMI）变化）、相关医学问题缓解情况（糖尿病和高血压）以及术后结局（并发症、住院时间和手术时间）。对均值差（MD）进行Meta分析以评估连续性结局，对比值比（OR）进行Meta分析以评估分类变量；采用随机效应模型。
结果
分析了8项研究，共4259例患者（1625例行SADI-S；2634例行RYGB）。纳入6项随访超过2年（平均3.93年（1.79））的研究以评估长期结局，而所有8项研究均纳入短期结局分析。SADI-S导致总体重减轻在统计学上显著更高（MD 10.03；95%CI 4.7 - 15.35；p < 0.001）、超重减轻更多（MD 10.15；95%CI 5.2 - 15.1；p < 0.01）、糖尿病缓解率更高（OR 3.48；95%CI 2.02 - 6.02；p < 0.001），且长期并发症数量相似（OR = 0.19，95%CI 0.03 - 1.36；p = 0.10）。在BMI < 50 kg/m²的接受SADI-S手术的患者亚组中，短期并发症较少（OR 0.45，95%CI 0.33至0.61；p < 0.01），住院时间也较短（MD = -0.69；95%CI -1.03至 -0.36，p < 0.01），严重并发症也较少（OR = 0.44，95%CI 0.25 - 0.80；p = 0.01）。
结论
这项Meta分析表明，在体重减轻、糖尿病缓解和安全性方面，SADI-S可能优于RYGB。
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