Department of Surgery, University of Minnesota Medical School, 420 Delaware Street SE, MMC 290, Minneapolis, MN 55455, USA.
Rev Endocr Metab Disord. 2009 Sep;10(3):215-29. doi: 10.1007/s11154-009-9112-x.
Weight loss surgery is recommended for adult patients with morbid obesity and has been used on a case by case basis in the pediatric population. Surgery, however,is just a tool added to the two mainstays of therapy for obesity: 1.) controlled dietary intake and 2.) increases inactivity and exercise behaviors. For the pediatric population,the health consequences of obesity are profound with increased cardiovascular risk during adolescence and increased mortality in adulthood. Currently accepted guidelines for weight loss surgery referral use BMI cut points that are the same as for adults: BMI > or = 35 kg/m(2) and serious comorbidities of obesity or BMI > or = 40 kg/m(2) with minor comorbidities of obesity. A multidisciplinary approach to weight management must be utilized, and a lifetime of follow-up must be addressed. The most commonly performed operations for obesity are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). LAGB is safer and does not permanently alter gastrointestinal continuity; however, LAGB is not currently approved for implantation in adolescent patients. LRYGB involves a complex, permanent altering of the gastrointestinal anatomy and is associated with more complications around the time of surgery and is not subject to FDA approval because there is no associated implant. In each operation, appetite is suppressed by construction of a virtual (LAGB) or real(LRYGB) pouch. The dynamics and speed of appetite suppression and, consequently, weight loss are typically different for each operation though longer-term outcomes may be similar. Short- and long-term risks of surgery must be carefully weighed against the benefits of the associated weight loss for each patient. The patient must be empowered to understand the importance of lifestyle and behavior in achieving long-term health.
减肥手术推荐用于病态肥胖的成年患者，并已在儿科人群中根据具体情况使用。然而，手术只是治疗肥胖的两个主要方法的补充：1.）控制饮食摄入和 2.）增加不活动和运动行为。对于儿科人群，肥胖的健康后果是深远的，青少年时期心血管风险增加，成年后死亡率增加。目前，减肥手术转诊的指南使用与成年人相同的 BMI 切点：BMI >或= 35 kg/m(2) 并伴有肥胖的严重合并症，或 BMI >或= 40 kg/m(2) 并伴有肥胖的轻微合并症。必须采用多学科方法进行体重管理，并解决终身随访问题。肥胖最常进行的手术是腹腔镜可调胃束带术（LAGB）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）。LAGB 更安全，不会永久改变胃肠道连续性；然而，LAGB 目前不批准用于植入青少年患者。LRYGB 涉及胃肠道解剖结构的复杂、永久性改变，并且在手术时更可能出现并发症，并且不受 FDA 批准，因为没有相关植入物。在每种手术中，通过构建虚拟（LAGB）或真实（LRYGB）袋来抑制食欲。尽管长期结果可能相似，但每种手术的食欲抑制和体重减轻的动态和速度通常不同。必须仔细权衡手术的短期和长期风险与相关体重减轻的益处，以使每个患者都能理解生活方式和行为在实现长期健康方面的重要性。
