Objective: To evaluate the mid-term efficacy of single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in the treatment of obesity and type 2 diabetes mellitus. Methods: The cohort of this retrospective observational study comprised 118 obese patients with body mass index (BMI) ≥40 kg/m2 with or without other related metabolic diseases and BMI of (27.5-40.0) kg/m2 with type 2 diabetes mellitus (T2DM) who had been treated with SADI-S. Patients who had undergone modified surgery or been followed up for less than 1 year were excluded. Clinical data of the included patients [56 men and 62 women aged (34.5±9.7) years], who had undergone SADI-S in China-Japan Union Hospital, Jilin University from October 2018 to August 2022, were collected. Their mean preoperative body mass was (125.9±25.0) kg and BMI (42.8±6.8) kg/m2. The 60 patients with T2DM had a mean fasting blood glucose of (9.9±3.2) mmol/L and HBA1c of (8.4±1.7) % before surgery. The main outcome measures were mid-term weight loss after surgery (body mass, BMI, excess weight loss, and total weight loss) 1, 2, 3, and 4 years after surgery and efficacy regarding diabetes mellitus (fasting blood glucose, glycated hemoglobin and diabetes remission rate at 1, 2, and 3 years after surgery). Outcomes were defined as follows. Complete remission: HbA1c <6% or fasting blood glucose <6 mmol/L without hypoglycemic medication; partial remission: HBA1c <6.5% or fasting blood glucose <7 mmol/L without hypoglycemic medication; significant improvement: HBA1c <7.0%, stable decrease of at least 1% compared with preoperative HBA1c, and postoperative dose of hypoglycemic medication significantly less; ineffective: no change in HBA1c and no reduction in dosage of hypoglycemic medication. Other outcome measures included intraoperative and postoperative adverse effects and postoperative nutritional indexes. Results: SADI-S was successful in all patients. There was no significant bleeding, conversion to open surgery, or perioperative death. The operation time was (186.1±41.5) minutes, and the postoperative hospital stay 6 (5-7) days. Surgical complications occurred in four patients, comprising peritoneal effusion, internal jugular vein thrombosis, anastomotic leakage, and gastric fistula. Body weight and BMI 1, 2, 3 and 4 years were significantly lower post- than pre-operatively (all P<0.05). Excess weight loss was (81.9±16.2) %, (82.2±15.5) %, (88.3±20.1) %, and (83.2±18.1) % at 1, 2, 3, and 4 years postoperatively, respectively. Total weight loss was (39.7±8.7) %, (40.6±10.6) %, (42.2±11.5) % and (45.4±10.2) %, respectively. The mean fasting blood glucose concentrations of the 60 patients with T2DM were (5.1±1.0) mmol/L, (5.0±0.7) mmol/L, and (5.4±0.9) mmol/L 1, 2 and 3 years postoperatively, respectively. The values for glycosylated hemoglobin were (4.9±0.6) %, (4.8±0.5) %, and (5.1±0.8) %, respectively, all of which are significantly lower than preoperatively (all P<0.05). The complete remission rate of diabetes was 95.0% (38/40), 90.0% (36/40), and 9/13 1, 2, and 3 years postoperatively, respectively. Additionally, the partial remission rate and significant improvement rate were both 100%. Two years postoperatively, the incidence of anemia was 27.8% (10/36), of hypoproteinemia 11.8% (4/34), and of ferritin deficiency 25.8% (8/31), all of which were improved by conservative treatment such as blood transfusion, iron supplementation, and adjustment of diet. Conclusion: SADI-S has a significant mid-term beneficial effect on weight loss and diabetes remission status in patients with obesity and type 2 diabetes.
目的： 评估单吻合口十二指肠回肠旁路联合袖状胃切除术（SADI-S）治疗肥胖症及2型糖尿病的中期疗效。 方法： 为回顾性观察性研究。纳入接受SADI-S治疗的体质指数（BMI）≥40 kg/m2而无论是否合并其他相关代谢病以及BMI 27.5~40.0 kg/m2且合并2型糖尿病（T2DM）的肥胖症患者，排除接受修正手术和随访时间<1年的患者。收集2018年10月至2022年8月期间在吉林大学中日联谊医院接受SADI-S治疗的118例肥胖症患者的临床资料，男性56例，女性62例，年龄（34.5±9.7）岁；术前体质量（125.9±25.0）kg，BMI为（42.8±6.8）kg/m2；其中60例患者合并T2DM，其术前空腹血糖为（9.9±3.2）mmol/L，糖化血红蛋白为（8.4±1.7）%。主要观察指标为术后中期的减重效果［包括术后1、2、3、4年的体质量、BMI、多余体质量减少率（%EWL）及总体质量减少率（%TWL）］和治疗糖尿病的疗效，包括术后1、2、3年空腹血糖、糖化血红蛋白及糖尿病缓解率（完全缓解：在不使用降糖药物情况下糖化血红蛋白<6%，或空腹血糖<6 mmol/L；部分缓解：在不使用降糖药物情况下糖化血红蛋白<6.5%，或空腹血糖<7 mmol/L；显著改善：糖化血红蛋白<7.0%，与术前糖化血红蛋白相比稳定下降至少1%，并且术后降糖药物剂量显著下降；无效：糖化血红蛋白无变化，服用药量未减少）。其他观察指标包括术中术后情况以及术后营养素指标。 结果： 所有患者均顺利完成SADI-S手术，手术过程顺利，无明显出血及中转开腹病例，围手术期无死亡病例发生。手术时间（186.1±41.5）min，术后住院时间为6（5~7）d。4例患者出现手术并发症，分别为腹腔积液、颈内静脉血栓、吻合口漏及胃瘘。术后体质量、BMI在术后1、2、3和4年的变化均较术前明显下降，差异均有统计学意义（均P<0.05）。术后1、2、3和4年，%EWL分别为（81.9±16.2）%、（82.2±15.5）%、（88.3±20.1）%和（83.2±18.1）%，%TWL分别为（39.7±8.7）%、（40.6±10.6）%、（42.2±11.5）%和（45.4±10.2）%。术后1、2、3年，60例合并T2DM的患者，空腹血糖分别为（5.1±1.0）mmol/L、（5.0±0.7）mmol/L和（5.4±0.9）mmol/L，糖化血红蛋白分别为（4.9±0.6）%、（4.8±0.5）%和（5.1±0.8）%，较术前均明显下降，差异均有统计学意义（均P<0.05）。术后1、2和3年，糖尿病完全缓解率分别为95.0%（38/40）、90.0%（36/40）和9/13，部分缓解率和显著改善率均为100%。术后2年，贫血发生率为27.8%（10/36），低蛋白血症发生率为11.8%（4/34），铁蛋白缺乏发生率为25.8%（8/31），均通过输血、补充铁剂和调整饮食等保守治疗得以改善。 结论： 肥胖症及2型糖尿病患者经SADI-S治疗其减重和糖尿病缓解的中期疗效明显。.