ObjectiveTo analyze why sleeve gastrectomy (SG) with jejunojejunal bypass (SG-JJB), despite being the second most common bariatric procedure in China, has not been recommended in national and international guidelines nor endorsed by expert consensus; to investigate the primary obstacles to its standardization and widespread adoption; and to propose strategies leveraging China’s extensive clinical experience to refine the technique, establish standardized protocols, and address existing challenges, thereby defining its future role in metabolic surgery. MethodsBy systematically reviewing the evolution, current evidence profile, and distinctive features of SG-JJB compared to other SG-Plus procedures, this study aimed to identify constraints hindering its adoption. Concurrently, considering the characteristics of domestic healthcare resources, we explored the feasibility of procedural refinements, key steps for standardization, and solutions to potential challenges, thereby facilitating the optimization and standardization of SG-JJB. ResultsThe three key constraints hindering SG-JJB development were: risks of blind loop syndrome, uncertainty regarding optimal bypass limb length, and limited evidence on long-term efficacy. To address these issues, this study proposed leveraging China’s clinical and multi-center collaboration strengths to: conduct high-quality studies defining the impact of bypass length on outcomes, establish unified diagnostic and monitoring protocols for blind loop syndrome, and systematically collect longitudinal data to evaluate long-term efficacy, thereby informing evidence-based surgical standardization. ConclusionsSG-JJB holds significant potential in Chinese bariatric-metabolic practice, yet its standardization faces persistent challenges. Addressing concerns about blind loop syndrome, defining optimal bypass limb length, and accumulating robust long-term efficacy data are pivotal for advancing SG-JJB standardization and adoption. Leveraging domestic clinical resources through multi-center collaborations, high-quality research, and evidence-based protocol development is the essential pathway to overcoming these barriers, achieving standardized implementation, and securing recognition in authoritative guidelines.
目的 探討經轉化生長因子-β1 ( TGF-β1) 基因修飾的未成熟樹突狀細胞(imDC) 預處理大鼠小腸移植受體后的外周血及移植腸浸潤T 細胞的變化及意義。方法 選用近交系F344/ N 和BN 大鼠建立全小腸異位移植模型,實驗分4 組(每組24 只) : 同基因移植組(BN-BN 組) 、異基因移植組( F344/ N-BN 組) 、異基因移植+ TGF-β1 基因轉染imDC 組( F344/ N-BN + TGF2β1 組) 和異基因移植+ TGF-β1 基因轉染imDC + FK506 組( F344/ N-BN + TGF-β1 + FK506 組) 。各組大鼠分別于術后3 、5 、7 d 各處死6 只,獲取大鼠靜脈血和移植腸。應用免疫組化SABC 法檢測受體鼠外周血及移植腸CD4 + 、CD8 + 、CD25 + 細胞和IL-4 的表達。同時行移植腸組織病理學檢查并觀察大鼠生存情況。結果 TGF-β1 修飾的DC 細胞能顯著抑制外周血及移植腸浸潤淋巴細胞CD4 + 、CD8 + 及CD25 + 的表達,并提高IL-4 的表達; 顯著延長受體大鼠的生存時間,但移植腸仍有排斥反應的病理組織學征象。結論 TGF-β1 修飾的DC 通過影響受體外周血及移植腸浸潤T 細胞對大鼠小腸移植發揮免疫抑制作用。