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背景近年来,肥胖病的发生率明显提高,对公共健康构成了严重威胁。世界卫生组织认为肥胖病是大多数发达国家和发展中国家的流行病。目前,肥胖症患者在中国正逐年增加,由肥胖引发的高血压、糖尿病、冠心病等正日益危害着人们的健康。成年人减肥手术已被广泛接受,对于青少年减肥手术治疗存在诸多争议。本文旨在分享本研究中心近几年减肥手术在肥胖青少年中应用的经验及体会。病例病例10例(女性8例,男性2例),13.5~18岁(平均16.4岁)接受手术并接受术后1年的随访。术前平均体重指数(BMI)为42.6kg/m2,术前平均s UA(血清尿酸)为472.7μmol/L。合并症包括高血压、胰岛素抵抗、高脂血症、高尿酸血症等,其中1名患者患有小胖威利综合征。10例患者术前均进行过药物、运动等减肥方式,均因效果不佳或无法坚持后出现体重反弹。其中5例行精准腹腔镜胃旁路手术,5例行腹腔镜胃袖状切除术。结果患者均未发生严重的术后并发症。所有患者均顺利在腹腔镜完成手术,无中转开腹手术或死亡病例,在术后1年的随访过程中,患者各种合并症在术后均得到不同程度的缓解。体重指数均呈下降趋势,术后1年平均BMI为31.4 kg/m2,与术前相比,术后1年平均BMI下降11.0kg/m2,P<0.05。术前s UA平均为472.7μmol/L,术后1年平均为404.2μmol/L,P<0.05。结论在青少年减重手术的选择应相对谨慎,也应采取更加积极主动的态度。对青少年患者行减重手术对改善肥胖症及代谢性疾病近期疗效明显,但远期疗效不明确,需要完善青少年减重手术大样本的前瞻性研究,制定完善合理的诊治指南,以及建立一个包括内分泌科、儿科、心理科、外科等多学科诊治体系。
Background In recent years, the incidence of obesity has significantly increased, posing a serious threat to public health. The World Health Organization considers obesity a pandemic in most developed and developing countries. At present, the number of obese patients is increasing in China. Hypertension, diabetes and coronary heart disease caused by obesity are increasingly endangering people’s health. Adult weight-loss surgery has been widely accepted, there are many controversies for the treatment of young weight-loss surgery. The purpose of this article is to share experiences and experiences gained by bariatric surgery in obese adolescents in recent years. Ten cases (8 females, 2 males) and 13.5 to 18 years (mean 16.4 years) underwent surgery and were followed up for 1 year postoperatively. The preoperative mean body mass index (BMI) was 42.6 kg / m2 and the mean preoperative sUA (serum uric acid) was 472.7 μmol / L. Complications include hypertension, insulin resistance, hyperlipidemia, hyperuricemia and so on. One of the patients had obesity Willys syndrome. Ten patients underwent preoperative medication, exercise and other weight loss methods, both due to poor performance or can not adhere to the rebound after weight loss. Among them, 5 cases underwent accurate laparoscopic gastric bypass surgery and 5 cases underwent laparoscopic gastric sleeve sleeve resection. Results None of the patients experienced serious postoperative complications. All patients successfully laparoscopic surgery, no laparotomy or death cases, 1 year after the follow-up process, patients with various comorbidities were relieved to varying degrees after surgery. Body mass index showed a downward trend. The mean BMI at 1 year after operation was 31.4 kg / m2. Compared with preoperative, the average BMI at 1 year after operation decreased by 11.0 kg / m2 (P <0.05). Preoperative uA average 472.7μmol / L, 1 year after the average was 404.2μmol / L, P <0.05. Conclusions The choice of bariatric surgery should be relatively cautious and should take a more proactive attitude. Adolescent patients with weight loss surgery to improve obesity and metabolic diseases in the near future obvious effect, but the long-term efficacy is not clear, the need to improve adolescent weight loss surgery large sample of prospective studies to develop a sound and reasonable diagnosis and treatment guidelines, and to establish a Endocrinology, pediatrics, psychology, surgery and other multidisciplinary diagnosis and treatment system.