Lawson M Louise, Kirk Shelley, Mitchell Terry, Chen Mike K, Loux Tara Jean, Daniels Stephen R, Harmon Carroll M, Clements Ronald H, Garcia Victor F, Inge Thomas H
Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45255, USA.
J Pediatr Surg. 2006 Jan;41(1):137-43; discussion 137-43. doi: 10.1016/j.jpedsurg.2005.10.017.
BACKGROUND/PURPOSE: Little is known about the metabolic outcomes of adolescent bariatric surgery. We report changes in weight, metabolic profile, and types of complications seen in a multicenter cohort.
One-year outcomes were included. For weight loss comparisons, a nonsurgical cohort (n = 12) was used. The primary outcome was weight change (n = 30) and secondary outcomes were metabolic variables (n = 24) and complications (n = 36). Data were analyzed using signed rank or paired t tests.
Mean body mass index fell 37% (from 56.5 preoperatively to 35.8 kg/m2; P < .001) in surgical patients and 3% (from 47.2 to 46 kg/m2; P = NS) in nonsurgical patients. Surgical patients showed significant improvements in triglycerides (-65 mg/dL), total cholesterol (-28 mg/dL), fasting blood glucose (-12 mg/dL), and fasting insulin (-21 microM/mL]). Improvement in high-density lipoprotein cholesterol (-3.9 mg/dL) and low-density lipoprotein cholesterol (-8.8 mg/dL) was not statistically significant. Sixty-one percent of surgical patients had no complications. Of 15 patients with complications, 9 had minor complications with no long-term sequelae, 4 had at least 1 moderate complication with sequelae for at least 1 month and 2 had at least 1 severe medical complication with long-term consequences (including beriberi and death). There were no perioperative deaths or other severe surgical complications in this series.
Postoperatively, adolescents lose significant weight and realize major metabolic improvements. The complication profile compares favorably to severely obese (body mass index >40 kg/m2) adults; however, small sample size precludes calculation of complication rates. Although there are considerable risks of bariatric surgery, early experience suggests that risks are offset by health benefits.
背景/目的：关于青少年减肥手术的代谢结果，人们了解甚少。我们报告了一个多中心队列中体重、代谢指标的变化以及并发症类型。
纳入一年期的结果。为进行体重减轻比较，使用了一个非手术队列（n = 12）。主要结果是体重变化（n = 30），次要结果是代谢变量（n = 24）和并发症（n = 36）。数据采用符号秩和检验或配对t检验进行分析。
手术患者的平均体重指数下降了37%（从术前的56.5降至35.8 kg/m²；P <.001），非手术患者下降了3%（从47.2降至46 kg/m²；P =无统计学意义）。手术患者的甘油三酯（-65 mg/dL）、总胆固醇（-28 mg/dL）、空腹血糖（-12 mg/dL）和空腹胰岛素（-21 microM/mL）有显著改善。高密度脂蛋白胆固醇（-3.9 mg/dL）和低密度脂蛋白胆固醇（-8.8 mg/dL）的改善无统计学意义。61%的手术患者无并发症。在15例有并发症的患者中，9例有轻微并发症且无长期后遗症，4例至少有1例中度并发症且有至少1个月的后遗症，2例至少有1例严重医疗并发症且有长期后果（包括脚气病和死亡）。本系列中无围手术期死亡或其他严重手术并发症。
术后，青少年体重显著减轻，代谢有重大改善。并发症情况与严重肥胖（体重指数>40 kg/m²）的成年人相比更有利；然而，样本量小妨碍了并发症发生率的计算。尽管减肥手术有相当大的风险，但早期经验表明，健康益处可抵消风险。
