傳統縮胃術後，每 3–4 人就有 1 人出現新發胃食道逆流。最新發表於《Obesity Surgery》的統合分析（7 項研究、2,912 名患者）顯示：加做雙通道吻合的 SASI、SASJ 手術，能將新發逆流風險降低 4.5 倍，既有逆流的緩解率更高達 88.4%。 After standard sleeve gastrectomy, 1 in 3–4 patients develop new-onset acid reflux. A meta-analysis in Obesity Surgery (7 studies, 2,912 patients) shows that SASI and SASJ bipartition procedures reduce this risk 4.5-fold, with an 88.4% resolution rate for pre-existing reflux.
袖狀胃切除術（縮胃手術）是目前全球執行量最大的減重手術，佔所有代謝手術的一半以上。它在短期的減重與代謝改善成效上表現優異——但有一個不應被忽視的長期代價：胃食道逆流（GERD）。
Sleeve gastrectomy (SG) is the most widely performed bariatric procedure worldwide, accounting for over half of all metabolic surgeries. Its short-term weight loss and metabolic benefits are excellent — but there is one long-term consequence that cannot be ignored: gastroesophageal reflux disease (GERD).
系統性文獻回顧顯示，縮胃術後有 20–35% 的患者出現新發胃食道逆流。更令人擔憂的是，長期追蹤（10 年）研究發現，高達 15% 的患者可能發展成 Barrett's 食道——一種食道腺癌的癌前變化。部分症狀嚴重的患者最終需要接受手術修正。
Systematic reviews show that 20–35% of sleeve gastrectomy patients develop new-onset GERD. More concerning, long-term follow-up (10 years) shows that up to 15% may develop Barrett's oesophagus — a premalignant condition linked to oesophageal adenocarcinoma. Some patients with severe symptoms ultimately require surgical revision.
為什麼縮胃會造成逆流？原因是多方面的：縮胃後胃腔變小、胃內壓力升高；賁門角（食道進入胃的角度）因手術改變；下食道括約肌受到的壓力降低；加上胃排空速度的改變——這些因素加在一起，讓胃酸更容易「爬上來」。
Why does sleeve gastrectomy cause reflux? The causes are multifactorial: the smaller gastric volume increases intragastric pressure; the angle of His (where the oesophagus meets the stomach) is altered by surgery; lower oesophageal sphincter pressure decreases; and gastric motility changes. Together, these factors make it easier for stomach acid to travel upward.
雙通道手術（Transit Bipartition，縮寫 TB）是在縮胃手術的基礎上，額外在胃的下方（胃竇）與小腸之間建立一個側側吻合（旁路出口），讓食物同時保有兩條離開胃部的路徑：一條走正常的十二指腸，一條走新建立的腸道出口。
Transit bipartition (TB) builds on sleeve gastrectomy by adding a side-to-side anastomosis between the lower stomach (gastric antrum) and the small intestine, creating a second gastric outlet. Food can now leave the stomach via two pathways: the normal duodenal route, and the newly created intestinal bypass.
目前臨床上主要有兩種變化術式。本中心以 SASJ 為主要術式，同時亦依個別患者狀況選擇最適合的手術設計：
Two main variants are currently used in clinical practice. Our centre performs primarily SASJ, with the surgical approach tailored to each patient's individual needs:
在縮胃後，將胃竇與距離迴盲瓣 200–350 公分的迴腸進行側側吻合。這條「遠端旁路」讓部分食物能直接接觸遠端腸道，大幅促進 GLP-1 等腸泌素的分泌，帶來強效的代謝改善與減重效果。
After sleeve gastrectomy, a side-to-side anastomosis connects the gastric antrum to the ileum 200–350 cm from the ileocaecal valve. This "distal bypass" allows food to reach the distal intestine directly, strongly stimulating GLP-1 and other gut hormones for powerful metabolic and weight loss benefits.
在縮胃後，將胃竇與距 Treitz 韌帶約 150–200 公分的空腸進行吻合，位置較 SASI 更近端，膽胰分流較短，理論上保留更多的近端營養吸收，同時仍可達到良好的代謝與逆流改善效果。
After sleeve gastrectomy, the gastric antrum is anastomosed to the jejunum approximately 150–200 cm from the ligament of Treitz. The anastomosis is more proximal than SASI, creating a shorter biliopancreatic limb that theoretically preserves more proximal nutrient absorption while still achieving favourable metabolic and anti-reflux outcomes.
2026 年，Noel 等人在《Obesity Surgery》發表了迄今最完整的雙通道手術 GERD 統合分析，納入 7 項研究、2,912 名患者，系統性評估 SASI 與 SASJ 兩種術式相較於傳統縮胃手術的逆流結果。
In 2026, Noel and colleagues published the most comprehensive meta-analysis to date on GERD outcomes after bipartition procedures in Obesity Surgery — 7 studies, 2,912 patients — systematically comparing SASI and SASJ against standard sleeve gastrectomy.
| 指標Outcome | 傳統縮胃 （SG）Standard Sleeve |
雙通道 （SASI / SASJ）Bipartition (SASI / SASJ) |
|---|---|---|
| 新發胃食道逆流率De novo GERD rate | 20–35% | 4.9–7% |
| 術前逆流緩解率GERD resolution rate | 43% | 88.4% |
| 新發食道炎（內視鏡）Endoscopic esophagitis | 33.0% | 12.2% |
| 重度食道炎Severe esophagitis (LA-B+) | 21.2% | 7.1% |
| 10 年 Barrett's 食道風險10-year Barrett's risk | 最高 15% | 顯著降低（長期數據持續追蹤中）Significantly lower (long-term data pending) |
Wang 等人（2025 年，Surgical Endoscopy）在同一醫院、同一時期對 215 名患者進行直接比較（115 名接受 SASI 雙通道、100 名接受傳統縮胃），追蹤 12 個月。結果發現：
Wang et al. (2025, Surgical Endoscopy) directly compared 215 patients at a single centre over 12 months (115 bipartition, 100 standard sleeve). Key findings:
新發逆流：雙通道 7.0% vs 縮胃 29.0%（p<0.001）
De novo GERD: 7.0% bipartition vs 29.0% standard sleeve (p<0.001)
多變量分析確認：傳統縮胃是新發逆流的獨立危險因子，風險高出雙通道 4.5 倍（OR 4.536，95% CI 1.787–11.519，p=0.001）
Multivariate analysis confirmed: standard sleeve gastrectomy is an independent risk factor for developing GERD, conferring 4.5-fold increased odds compared to bipartition (OR 4.536, 95% CI 1.787–11.519, p=0.001)
同時，雙通道組的體重減輕也更顯著（12 個月多餘體重下降 112.0% vs 97.2%，p=0.001）。
Furthermore, bipartition achieved greater weight loss (%EWL at 12 months: 112.0% vs 97.2%, p=0.001).
根據現有研究，兩種術式的逆流緩解效果相近——SASI 緩解率約 89.5%，SASJ 約 88.5%；新發逆流率分別約 5.5% 與 6.0%，差異無統計學意義。術式的選擇主要依據患者的整體代謝狀況、BMI 程度、術者的熟練度及患者的個別需求，而非單純以逆流控制為決策依據。
Based on available evidence, both variants achieve similar reflux outcomes — SASI resolution approximately 89.5%, SASJ approximately 88.5%; de novo GERD rates of ~5.5% and ~6.0% respectively, with no statistically significant difference. The choice between variants is guided primarily by the patient's overall metabolic profile, BMI, surgeon expertise, and individual needs, rather than reflux control alone.
雙通道手術能顯著降低術後胃食道逆流，並非偶然——它的解剖設計從根本上改變了傳統縮胃造成逆流的幾個核心問題：
Bipartition surgery's superior reflux outcomes are not coincidental — its anatomical design directly addresses the core mechanisms that make standard sleeve gastrectomy cause reflux:
根據現有研究的建議，以下幾類患者在評估減重手術選項時，應特別重視雙通道手術（SASI/SASJ）相對於傳統縮胃的優勢：
Based on current evidence, the following patient groups should give particular weight to bipartition surgery (SASI/SASJ) over standard sleeve when evaluating their surgical options:
這類患者若接受傳統縮胃，症狀幾乎必然加重。雙通道手術的逆流緩解率高達 88.4%，是更合適的選擇。傳統縮胃在有逆流病史的患者身上是相對禁忌。
Standard sleeve in these patients will almost certainly worsen symptoms. With an 88.4% GERD resolution rate, bipartition is the more appropriate choice. Standard sleeve is a relative contraindication in patients with a history of reflux.
即使症狀不明顯，內視鏡已顯示食道損傷的患者，傳統縮胃可能讓黏膜病變持續惡化。建議術前完整的上消化道內視鏡評估。
Even if symptoms are mild, existing mucosal damage may worsen with standard sleeve. A complete upper GI endoscopy prior to surgery is strongly recommended for all bariatric surgical candidates.
SASI 在糖尿病緩解與代謝改善方面的效果顯著，同時附加了對逆流的保護。對這類患者而言，雙通道手術兼顧減重、代謝與逆流三大目標。
SASI demonstrates exceptional diabetes remission and metabolic improvement outcomes, with the added benefit of reflux protection. For these patients, bipartition simultaneously addresses weight loss, metabolic health, and reflux — three goals in one procedure.
研究顯示，以雙通道手術作為縮胃後的修正術式，逆流緩解率達 88%（Reiser 等人，2021）。若您在縮胃後仍有持續性逆流症狀，本中心可提供完整的評估與修正手術規劃。
Evidence shows that bipartition as a revisional procedure after sleeve gastrectomy achieves 88% GERD resolution (Reiser et al., 2021). If you experience persistent reflux after prior sleeve gastrectomy, our centre can provide comprehensive evaluation and revisional surgical planning.
雙通道手術有約 5.9% 的患者在術後追蹤胃鏡中發現膽汁逆流性胃炎（SASJ 約 6.6%，SASI 約 4.9%）。這與胃酸逆流不同——是膽汁從腸道往上逆流。好消息是，超過 95% 的案例可以透過藥物（熊去氧膽酸、質子幫浦抑制劑）有效控制，需要手術再處理的案例不到 0.7%。術後定期的胃鏡追蹤可及早發現並處理。
Approximately 5.9% of bipartition patients develop endoscopically confirmed bile reflux gastritis (SASJ ~6.6%, SASI ~4.9%). This differs from acid reflux — it involves bile flowing upward from the intestine. The good news: over 95% of cases are effectively managed with medication (ursodeoxycholic acid, PPIs), with fewer than 0.7% requiring surgical revision. Regular post-operative endoscopic surveillance can detect and address this early.
是的，而且比很多人預期的更普遍。系統性回顧顯示，縮胃術後有 20–35% 的患者出現新發胃食道逆流，長期（10 年）追蹤中更有高達 15% 的患者可能發展出 Barrett's 食道（食道癌前變化）。這是目前縮胃手術最受關注的長期併發症之一，也是近年外科界逐漸轉向加做腸道吻合（如 SASI、SASJ）的主要原因之一。
Yes, and more commonly than many people expect. Systematic reviews show that 20–35% of sleeve gastrectomy patients develop new-onset GERD, with up to 15% developing Barrett's oesophagus (a precancerous condition) on 10-year follow-up. This is one of the most closely watched long-term complications of sleeve gastrectomy, and a key reason the surgical community has increasingly moved toward adding an intestinal anastomosis (SASI, SASJ) to the sleeve.
根據 2026 年的最新統合分析（7 項研究、2,912 名患者），雙通道手術對術前已有胃食道逆流患者的緩解率達 88.4%，相比之下，傳統縮胃手術的緩解率僅約 43%。而新發逆流率，雙通道手術為 4.9–7%，傳統縮胃手術則為 20–35%——差距超過 4.5 倍。
According to the latest 2026 meta-analysis (7 studies, 2,912 patients), bipartition procedures achieve a GERD resolution rate of 88.4% in patients with pre-operative reflux, compared to only approximately 43% with standard sleeve gastrectomy. For de novo GERD, bipartition produces rates of 4.9–7% versus 20–35% with standard sleeve — a more than 4.5-fold difference.
術前已有胃食道逆流，是傳統縮胃手術（袖狀胃切除）的相對禁忌症。若單純執行縮胃手術，原有的逆流症狀幾乎可以確定會加重。對於這類患者，臨床上更建議考慮雙通道手術（SASI/SASJ）或其他能改善逆流的術式（如 OAGB 胃繞道）。術前完整的上消化道胃鏡評估是必要的。
Pre-existing GERD is a relative contraindication for standard sleeve gastrectomy. If a standard sleeve is performed in these patients, existing reflux symptoms will almost certainly worsen. For these patients, clinical practice increasingly favours bipartition surgery (SASI/SASJ) or other reflux-improving procedures such as OAGB gastric bypass. A complete upper GI endoscopy prior to surgery is essential.
可以。研究顯示，以雙通道手術作為縮胃後逆流的修正術式，逆流緩解率約 88%（Reiser 等，2021）。這是目前有依據的修正方向之一，但需要由有執行經驗的外科團隊完整評估，包括胃鏡、食道壓力測定、24 小時 pH 監測等術前評估，以確認病因並規劃最適合的修正方案。
Yes. Evidence shows that bipartition as a revisional procedure for post-sleeve GERD achieves approximately 88% reflux resolution (Reiser et al., 2021). This is one of the evidence-supported revisional approaches, but it requires comprehensive evaluation by an experienced surgical team — including endoscopy, oesophageal manometry, and 24-hour pH monitoring — to confirm the aetiology and plan the most appropriate revision.
是的，差距相當顯著。根據 Wang 等人 2025 年的直接頭對頭比較研究，SASJ 等雙通道手術的新發胃食道逆流率僅 7.0%，而傳統縮胃手術高達 29.0%（p<0.001）。多變量分析進一步確認，傳統縮胃是新發逆流的獨立危險因子，風險是雙通道手術的 4.5 倍（OR 4.536，p=0.001）。從內視鏡結果來看，縮胃組的食道炎發生率為 33.0%，雙通道組僅 12.2%——差距接近三倍。本中心以 SASJ 為主要術式，正是因為它在有效減重之餘，同時提供了對食道的顯著保護。
Yes, the difference is highly significant. In the Wang et al. 2025 head-to-head comparison, the de novo GERD rate with SASJ-type bipartition was just 7.0%, versus 29.0% with standard sleeve gastrectomy (p<0.001). Multivariate analysis confirmed that standard sleeve is an independent risk factor for developing GERD, conferring 4.5 times the odds compared to bipartition (OR 4.536, p=0.001). On endoscopy, oesophagitis was found in 33.0% of sleeve patients versus only 12.2% in the bipartition group — nearly a three-fold difference. Our centre's preference for SASJ as the primary procedure reflects precisely this advantage: effective weight loss with meaningful protection of the oesophagus.
是的。雙通道手術雖顯著降低胃食道逆流風險，但仍有約 5.9% 的患者在術後追蹤中發現膽汁逆流性胃炎，且膽汁長期刺激食道黏膜的遠期致癌風險目前仍在持續研究中。因此，術後定期的內視鏡追蹤（依個人狀況安排，通常建議每 1–2 年一次）仍是本中心建議的常規術後照護項目之一。
Yes. While bipartition significantly reduces GERD risk, approximately 5.9% of patients develop bile reflux gastritis detected on surveillance endoscopy, and the long-term carcinogenic potential of chronic bile exposure remains under ongoing investigation. Post-operative endoscopic surveillance (typically recommended every 1–2 years depending on individual circumstances) remains a standard part of post-operative care recommended by our centre.
高雄長庚體重管理中心執行 SASI、SASJ 雙通道手術多年，對術前有逆流症狀或術後出現逆流惡化的患者，提供完整的術前內視鏡評估與個人化手術規劃。
The CGMH Weight Management Centre has extensive experience in SASI and SASJ bipartition surgery. For patients with pre-existing reflux or those experiencing worsening reflux after prior bariatric surgery, we provide comprehensive pre-operative endoscopic evaluation and individualised surgical planning.
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