ObjectiveTo analyze why sleeve gastrectomy (SG) with jejunojejunal bypass (SG-JJB), despite being the second most common bariatric procedure in China, has neither been recommended in domestic and international guidelines nor endorsed by expert consensus; investigate the primary obstacles to its standardization and widespread adoption; and 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 distinctions of SG-JJB compared to other SG-Plus procedures, this study focused on identifying constraints hindering its adoption. Concurrently, considering the characteristics of domestic healthcare resources, we analyzed 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 challenges. Addressing concerns about blind loop syndrome, defining optimal bypass limb length, and accumulating robust long-term efficacy data are pivotal to 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 探讨经转化生长因子-β1 ( TGF-β1) 基因修饰的未成熟树突状细胞(imDC) 预处理大鼠小肠移植受体后的外周血及移植肠浸润T 细胞的变化及意义。方法 选用近交系F344/ N 和BN 大鼠建立全小肠异位移植模型,实验分4 组(每组24 只) : 同基因移植组(BN-BN 组) 、异基因移植组( F344/ N-BN 组) 、异基因移植+ TGF-β1 基因转染imDC 组( F344/ N-BN + TGF2β1 组) 和异基因移植+ TGF-β1 基因转染imDC + FK506 组( F344/ N-BN + TGF-β1 + FK506 组) 。各组大鼠分别于术后3 、5 、7 d 各处死6 只,获取大鼠静脉血和移植肠。应用免疫组化SABC 法检测受体鼠外周血及移植肠CD4 + 、CD8 + 、CD25 + 细胞和IL-4 的表达。同时行移植肠组织病理学检查并观察大鼠生存情况。结果 TGF-β1 修饰的DC 细胞能显著抑制外周血及移植肠浸润淋巴细胞CD4 + 、CD8 + 及CD25 + 的表达,并提高IL-4 的表达; 显著延长受体大鼠的生存时间,但移植肠仍有排斥反应的病理组织学征象。结论 TGF-β1 修饰的DC 通过影响受体外周血及移植肠浸润T 细胞对大鼠小肠移植发挥免疫抑制作用。