切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 217 -224. doi: 10.3877/cma.j.issn.1674-0793.2026.04.001

述评

减重手术新术式与新进展:从术式创新到策略融合
张宗明1,2,(), 刘立民1,2, 张翀1,2   
  1. 1 100073 北京,国家电网公司北京电力医院普外科
    2 100073 北京,中国通用技术集团肝胆疾病临床医学研究中心
  • 收稿日期:2026-04-08 出版日期:2026-08-01
  • 通信作者: 张宗明
  • 基金资助:
    北京市科技重大专项生物医药与生命科学创新培育研究项目(Z171100000417056); 国中康健集团科技项目(GZKJ-KJXX-QTHT-20230626,20240429)

New procedures and advances in bariatric surgery: from surgical innovation to strategic integration

Zongming Zhang1,2,(), Limin Liu1,2, Chong Zhang1,2   

  1. 1 Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
    2 Clinical Medical Research Center for Hepatobiliary Diseases in General Surgery, China General Technology Group, Beijing 100073, China
  • Received:2026-04-08 Published:2026-08-01
  • Corresponding author: Zongming Zhang
引用本文:

张宗明, 刘立民, 张翀. 减重手术新术式与新进展:从术式创新到策略融合[J/OL]. 中华普通外科学文献(电子版), 2026, 20(04): 217-224.

Zongming Zhang, Limin Liu, Chong Zhang. New procedures and advances in bariatric surgery: from surgical innovation to strategic integration[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(04): 217-224.

肥胖症已成为21世纪最具挑战性的公共卫生问题之一,其发病率持续攀升。减重与代谢手术(BMS)凭借确切持久的减重效果与显著的代谢合并症改善作用,已成为中重度肥胖症最有效的治疗手段和一线治疗方案,其中Roux-en-Y胃旁路术(RYGB)是国际公认的经典术式之一。本文系统梳理了BMS近5年的重要进展,涵盖手术适应证的显著拓展(包括低体重指数人群、青少年及老年患者)、新术式的评价与优化(包括单吻合口胃旁路术、单吻合口十二指肠回肠旁路联合袖状胃切除术、功能性袖状胃切除术),以及内镜下减重治疗的革新(如内镜下袖状胃成形术、经口出口缩小术及其新技术BARS系统、十二指肠黏膜表面重建术等)。值得关注的是,手术与以胰高血糖素样肽-1(GLP-1)受体激动剂为代表的新型减重药物联合应用,正在重塑肥胖治疗的格局。2024年,一项网络荟萃分析显示,替尔泊肽(抑胃肽/GLP-1双重受体激动剂)的减重效果已接近袖状胃切除术;而内镜下袖状胃成形术凭借良好的安全性,填补了药物治疗与外科手术之间的空白,但仍有待多中心、前瞻性研究进一步验证。未来,BMS将朝着精准化、微创化与整合化方向发展,通过多学科协作,实现肥胖症的个体化全程管理。

Obesity has emerged as one of the most challenging public health issues of the 21st century, with its incidence continuing to rise. Bariatric and metabolic surgery (BMS), with its definitive and sustained weight loss effects as well as remarkable improvement in metabolic comorbidities, has become the most effective therapeutic approach and first-line treatment for moderate to severe obesity. Among these procedures, Roux-en-Y gastric bypass (RYGB) is one of the internationally recognized classic surgical techniques. This article systematically reviews the major advances in BMS over the past five years, covering the substantial expansion of surgical indications (including individuals with low body mass index, adolescents, and elderly patients), the evaluation and optimization of novel procedures (including one-anastomosis gastric bypass, single-anastomosis duodeno-ileal bypass with sleeve gastrectomy, and functional sleeve gastrectomy), as well as innovations in endoscopic bariatric therapies including endoscopic sleeve gastroplasty, transoral outlet reduction, the novel BARS system, duodenal mucosal surface resurfacing, are also discussed. Notably, the combined use of surgery with novel anti-obesity drugs represented by glucagon-like peptide-1 (GLP-1) receptor agonists is reshaping the landscape of obesity treatment. A 2024 network meta-analysis reported that the weight loss efficacy of tirzepatide (a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist) is approaching that of sleeve gastrectomy. Meanwhile, endoscopic sleeve gastroplasty, with its favorable safety profile, fills the gap between pharmacotherapy and surgery, though further validation through multicenter, prospective studies is still needed. In the future, BMS will evolve towards greater precision, minimal invasiveness, and integration, enabling individualized, comprehensive management of obesity through multidisciplinary collaboration.

[1]
World Health Organization. Obesity and overweight [EB/OL]. WHO Website, 2025–12–08.
[2]
Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(6): 373–392.
[3]
国家卫生健康委员会. 中国居民营养与慢性病状况报告(2020年)[J]. 营养学报, 2020, 42(6): 521.
[4]
田沛荣, 张鹏. 减重与代谢手术研究进展[J]. 中华医学杂志, 2025, 105(37): 3337–3342.
[5]
李非, 张宗明. 消化道转流手术治疗2型糖尿病的研究进展[J]. 中华医学杂志, 2008, 88(38): 2733–2735.
[6]
Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery[J]. Obes Surg, 2023, 33(1): 3–14.
[7]
Clapp B, Ponce J, Corbett J, et al. American Society for Metabolic and Bariatric Surgery 2022 estimate of metabolic and bariatric procedures performed in the United States[J]. Surg Obes Relat Dis, 2024, 20(5): 425–431.
[8]
国家卫生健康委员会. 肥胖症诊疗指南(2024年版)[J]. 中国循环杂志, 2025, 40(1): 6–30.
[9]
王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4): 301–306.
[10]
曲伸, 陆灏, 宋勇峰. 基于临床的肥胖症多学科诊疗共识(2021年版)[J/OL]. 中华肥胖与代谢病电子杂志, 2021, 7(4): 211–226.
[11]
Burke E, Jenkins T, Boles RE, et al. Cognitive function 10 years after adolescent bariatric surgery[J]. Surg Obes Relat Dis, 2024, 20(7): 614–620.
[12]
Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: A review[J]. JAMA, 2020, 324(9): 879–887.
[13]
Qazi S, Ali H, Ansari H, et al. Effect of metabolic surgery on cardiovascular outcomes in people with obesity and pre-existing cardiovascular disease: A systematic review and meta-analysis[J]. Circulation, 2024, 150(Suppl 1): A4131100.
[14]
Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity[J]. JAMA, 2019, 322(13): 1271–1282.
[15]
Fisher DP, Johnson E, Haneuse S, et al. Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity[J]. JAMA, 2018, 320(15): 1570–1582.
[16]
Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial[J]. Lancet, 2021, 397(10271): 293–304.
[17]
Heneghan HM, Meron-Eldar S, Brethauer SA, et al. Effect of bariatric surgery on cardiovascular risk profile[J]. Am J Cardiol, 2011, 108(10): 1499–1507.
[18]
Schiavon CA, Cavalcanti AB, Oliveira JD, et al. Randomized trial of effect of bariatric surgery on blood pressure after 5 years[J]. J Am Coll Cardiol, 2024, 83(6): 637–648.
[19]
Samarasinghe SNS, Leca B, Alabdulkader S, et al. Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial[J]. Lancet, 2024, 403(10443): 2489–2503.
[20]
李坡, 陈文辉, 王存川, 等. 腹腔镜胃袖状切除术术后10年及以上结果的Meta分析[J]. 腹部外科, 2023, 36(5): 378–383.
[21]
朱江帆, 卢列盛. 腹腔镜胃袖状切除术:我们的做法与争议[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(1): 5–8.
[22]
陈文辉, 刘岩, 胡瑞祥, 等. 功能性袖状胃切除术: 一种新概念的减重手术方式[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(3): 163–169.
[23]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 精准肥胖代谢外科手术中国专家共识(2022版)[J]. 中华胃肠外科杂志, 2022, 25(10): 841–851.
[24]
Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: A systematic review[J]. Obes Surg, 2013, 23(11): 1922–1933.
[25]
El Ansari W, Elhag W. Weight regain and insufficient weight loss after bariatric surgery: definitions, prevalence, mechanisms, predictors, prevention and management strategies, and knowledge gaps-a scoping review[J]. Obes Surg, 2021, 31(4): 1755–1766.
[26]
Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass[J]. Clin Gastroenterol Hepatol, 2011, 9(3): 228–233.
[27]
Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up[J]. Gastrointest Endosc, 2016, 83(4): 776–779.
[28]
Jirapinyo P, de Moura DTH, Thompson CC. Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video)[J]. Gastrointest Endosc, 2020, 91(6): 1282–1288.
[29]
Jirapinyo P, Kumar N, AlSamman MA, et al. Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass[J]. Gastrointest Endosc, 2020, 91(5): 1067–1073.
[30]
Firkins SA, Sierra L, Khurana A, et al. Raising the BARS: first U. S. experience of a novel system for endoscopic gastrojejunal anastomosis revision[EB/OL]. Tech Innov Gastrointest Endosc, 2025, 250944[2026–04–08].
[31]
Saumoy M, Schneider Y, Zhou XK, et al. A single-operator learning curve analysis for the endoscopic sleeve gastroplasty[J]. Gastrointest Endosc, 2018, 87(2): 442–447.
[32]
Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): A prospective, multicentre, randomised trial[J]. Lancet, 2022, 400(10350): 441–451.
[33]
Hedjoudje A, Abu Dayyeh BK, Cheskin LJ, et al. Efficacy and safety of endoscopic sleeve gastroplasty: A systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2020, 18(5): 1043–1053, e4.
[34]
Kotinda A, de Moura DTH, Ribeiro IB, et al. Efficacy of intragastric balloons for weight loss in overweight and obese adults: A systematic review and meta-analysis of randomized controlled trials[J]. Obes Surg, 2020, 30(7): 2743–2753.
[35]
Singh S, de Moura DTH, Khan A, et al. Intragastric balloon versus endoscopic sleeve gastroplasty for the treatment of obesity: A systematic review and meta-analysis[J]. Obes Surg, 2020, 30(8): 3010–3029.
[36]
Daniel L, Qiuye C, Sam A, et al. 胃内球囊术治疗不同体质量指数肥胖症的短期临床疗效[J]. 中华消化外科杂志, 2022, 21(12): 1573–1578.
[37]
康军仁, 徐强, 李海龙, 等. 胃内球囊用于减重的临床研究进展[J]. 协和医学杂志, 2023, 14(3): 591–597.
[38]
周华梅, 吴晓颖, 张毅. 十二指肠黏膜表面重建术治疗2型糖尿病的研究进展[J]. 国际内分泌代谢杂志, 2022, 42(2): 146–149.
[39]
Mingrone G, van Baar AC, Devière J, et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial[J]. Gut, 2022, 71(2): 254–264.
[40]
Liu Yan. iWAIST Trial: ERCG (Endoscopic Radial Compression Gastroplasty) vs Optimized Lifestyle Intervention for Weight Loss(iWAIST-RCT)[C/OL]. NLM identifier: NCT07237750. 2025–11–20.
[41]
中华医学会消化内镜学分会胃病学组. 内镜下十二指肠-空肠旁路套管置入术减重专家建议(2025版)[J]. 中华消化内镜杂志, 2025, 42(7): 509–512.
[42]
Stratmann B, Krepak Y, Schiffer E, et al. Beneficial metabolic effects of duodenal jejunal bypass liner for the treatment of adipose patients with type 2 diabetes mellitus: analysis of responders and non-responders[J]. Horm Metab Res, 2016, 48(10): 630–637.
[43]
中华医学会消化内镜学分会微创减重治疗协作组, 中国医师协会消化医师分会减重专业委员会, 国家消化系统疾病临床医学研究中心(北京). 中国肥胖症消化内镜治疗专家共识[J]. 中华消化内镜杂志, 2024, 41(1): 1–10.
[44]
Patel N, Mohanaruban A, Ashrafian H, et al. EndoBarrier®: A safe and effective novel treatment for obesity and type 2 diabetes?[J]. Obes Surg, 2018, 28(7): 1980–1989.
[45]
Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity[J]. N Engl J Med, 2022, 387(3): 205–216.
[46]
Nadolsky KZ, Agarwal M. Once-weekly semaglutide in adults with overweight or obesity[J]. N Engl J Med, 2021, 385(1): e4.
[47]
Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3. 0 mg of liraglutide in weight management[J]. N Engl J Med, 2015, 373(1): 11–22.
[48]
Velji-Ibrahim J, Radadiya D, Devani K. Comparative efficacy and safety of bariatric surgery, bariatric endoscopy, and GLP-1 receptor agonists in obesity management: A network meta-analysis[J]. Am J Gastroenterol, 2024, 119(10S): S1472–S1473.
[49]
Ghusn W, Divakar A, Salameh Y, et al. Emerging trends in endoscopic bariatric therapies: personalization through genomics and synergistic pharmacotherapy[J]. J Clin Med, 2025, 14(13): 4681.
[50]
de Waal JR, Nieuwdorp M, Gerdes VEA. The effect of combining surgical or endoscopic bariatric interventions with anti-obesity medication or probiotics on weight loss: A narrative review[J]. Front Endocrinol (Lausanne), 2026, 17: 1680182.
[51]
Sharaiha RZ, Hajifathalian K, Kumar R, et al. Five-year outcomes of endoscopic sleeve gastroplasty for the treatment of obesity[J]. Clin Gastroenterol Hepatol, 2021, 19(5): 1051–1057, e2.
[52]
中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2023年度报告[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(2): 73–83.
[53]
中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会胃食管反流疾病诊疗外科专家工作组, 日本肥胖治疗学会, 等. 袖状胃切除术患者胃食管反流病诊治中日韩专家上海共识(2024版)[J]. 中华消化外科杂志, 2024, 23(9): 1140–1157.
[54]
Akwe J, Fongeh K, Jung S, et al. Medical vs surgical obesity management: A narrative review of efficacy, safety, and long-term outcomes[J]. Cureus, 2025, 17(9): e91677.
[1] 邓宝, 郭子琳, 仲雷. 乳腺癌治疗中的铁死亡机制与铁基纳米材料应用进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 362-368.
[2] 毕小成, 王文霞, 邵金龙, 葛少华. Ⅳ期牙周炎伴病理性牙移位患者的多学科联合治疗[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(04): 229-239.
[3] 侯世豪, 许杰, 田蓓敏, 陈发明, 张曦予. Ⅲ期C级牙周炎合并畸形舌侧沟患者的牙周-牙体-正畸多学科治疗[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(04): 256-263.
[4] 谭进富, 管春菠, 朱文. 腹腔镜下袖状胃切除术[J/OL]. 中华普通外科学文献(电子版), 2026, 20(03): 175-175.
[5] 方郁晖, 常钰泉, 何坤. 伴微血管侵犯的肝细胞癌术后辅助介入治疗的研究进展[J/OL]. 中华普通外科学文献(电子版), 2026, 20(01): 53-59.
[6] 康星, 俞杭, 单晓东, 孙喜太, 褚薛慧. 单孔腹腔镜袖状胃切除术围手术期血液管理措施的比较研究[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 18-21.
[7] 周哲琦, 艾克拜尔·艾力, 李义亮, 麦麦提艾力·麦麦提明, 玉素江·图荪托合提, 克力木·阿不都热依木. 机器人辅助与腹腔镜袖状胃切除联合胃底折叠及食管裂孔疝修补术的临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 259-264.
[8] 崔梦玲, 孙文梅, 赵睿敏, 王家平. 合并微血管侵犯肝癌术后TACE联合治疗的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 160-166.
[9] 秦松涵, 王继伟, 张桃, 谢铭. 自噬在结直肠癌发生与发展中的作用及研究进展[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(03): 263-268.
[10] 罗子嫣, 王婷, 蒋梅, 郑蜜蜜, 胡娟. 血液灌流治疗对维持性血液透析患者微炎症状态的影响研究进展[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 206-212.
[11] 邱于恒, 李俊红. 把握近视防控的新进展[J/OL]. 中华眼科医学杂志(电子版), 2026, 16(01): 1-8.
[12] 印于, 俞斌, 冯文聪, 杨俊, 倪才方, 朱晓黎, 李智, 李明明. 动脉化疗栓塞联合锥形束断层扫描引导乙醇注射治疗危险部位小肝癌的疗效与安全性[J/OL]. 中华介入放射学电子杂志, 2026, 14(02): 157-163.
[13] 杨兴源, 向婷, 周庆. 腹腔镜袖状胃切除术与Roux-en-Y胃旁路术对肥胖合并阻塞性睡眠呼吸暂停患者术后代谢及胃食管反流病影响的研究进展[J/OL]. 中华胃食管反流病电子杂志, 2026, 13(01): 49-55.
[14] 陈熊熊, 熊见武, 沈宗文, 杨磊, 李滢旭. 减重手术围术期利拉鲁肽致术中反流及胃内容物残留1例[J/OL]. 中华肥胖与代谢病电子杂志, 2026, 12(01): 78-83.
[15] 张克玲, 于丹. 急性缺血性卒中再灌注治疗的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(06): 532-537.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?