瑞典全国研究（AMOS）：腹腔镜 Roux-en-Y 胃旁路术治疗青少年严重肥胖症的两年结果。

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS).

机构信息

Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Medicine, Clinical Physiology and Paediatrics (Queen Silvia Children's Hospital), Gothenburg, Sweden.

出版信息

Int J Obes (Lond). 2012 Nov;36(11):1388-95. doi: 10.1038/ijo.2012.160. Epub 2012 Sep 25.

DOI:10.1038/ijo.2012.160

PMID:23007037

Abstract

CONTEXT

The prevalence of obesity among adolescents has increased and we lack effective treatments.

OBJECTIVE

To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care.

DESIGN, SETTING AND PATIENTS: Intervention study for 81 adolescents (13-18 years) with a body mass index (BMI) range 36-69 kg m(-2) undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care.

MAIN OUTCOME MEASUREMENTS

Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group.

RESULTS

Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5 ± 6.1 (mean ± s.d.) at baseline and 30.2 (confidence interval 29.1-31.3) after 2 years (P<0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20 mU l(-1)) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients.

CONCLUSIONS

Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.

摘要

背景

青少年肥胖的患病率不断增加，但我们缺乏有效的治疗方法。

目的

在专业医疗机构中，确定胃旁路手术是否对患有病态肥胖的青少年患者安全有效。

设计、地点和患者：干预研究，81 名青少年（13-18 岁）的体重指数（BMI）范围为 36-69 kg/m2，在瑞典的一所大学医院接受腹腔镜胃旁路手术。为了比较体重变化，我们选择了一组成年胃旁路手术患者（n=81）和一组接受常规治疗的青少年患者（n=81）作为对照。

主要观察指标

所有组别的两年 BMI 结果，以及青少年手术组的代谢风险因素和生活质量。

结果

手术组的两年随访率为 100%，对照组为 73%。接受手术的青少年，术前 BMI 为 45.5±6.1（平均值±标准差），术后 2 年为 30.2（置信区间 29.1-31.3）（P<0.001），体重减轻 32%，多余 BMI 减少 76%。成年手术患者的 2 年减重为 31%，而常规治疗的青少年患者体重增加 3%。术前，70%的青少年手术患者存在高胰岛素血症（>20 mU/l），术后 1 年降为 0%，2 年降为 3%。其他心血管风险因素也得到改善。接受手术的青少年中，有三分之二有精神病史。尽管如此，治疗总体上耐受性良好，生活质量显著提高。33%的患者出现不良事件。