Thakkar Rajan K, Michalsky Marc P
Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Curr Opin Pediatr. 2015 Jun;27(3):370-6. doi: 10.1097/MOP.0000000000000223.
Recent evidence highlighting the prevalence of severe obesity in the pediatric population, coupled with disappointing outcomes related to medical weight loss interventions, has led to increased interest in bariatric surgery. This article focuses on recent additions to the literature regarding the current indications and outcomes of adolescent bariatric surgery, emerging guidelines on the development of surgical weight loss programs and the status of access to bariatric surgical care for adolescents in the United States.
Current data have shown a steady rise in the use of bariatric surgery among adolescents and serve to highlight the prevalence of several important obesity-related comorbidities. In addition to reports showing the safety and efficacy of adolescent bariatric surgery, a number of investigators have demonstrated significant improvement in key physiological and metabolic parameters (i.e., glucose metabolism, elevated blood pressure, dyslipidemia, etc.), offering updated consensus-driven guidelines for the indications for surgical intervention, as well as the development of multidisciplinary adolescent-specific care. Despite favorable outcomes, a disparity exists between the pediatric and adult populations related to access to such care.
In contrast to previous small and mostly retrospective series, contemporary studies have shown that adolescent bariatric surgery is well tolerated and effective. Despite these findings and the emergence of a national consensus regarding multidisciplinary care, skepticism among primary care providers, as well as significant challenges related to healthcare access, remain. Longitudinal studies and open dialogue within the medical community are needed.
近期证据凸显了儿科人群中重度肥胖的普遍性，再加上医学减肥干预效果不尽人意，这使得人们对减肥手术的兴趣增加。本文重点关注近期文献中有关青少年减肥手术的当前适应症和结果、减肥手术项目发展的新指南以及美国青少年获得减肥手术治疗的情况。
当前数据显示青少年减肥手术的使用呈稳步上升趋势，并凸显了几种重要的肥胖相关合并症的普遍性。除了报告显示青少年减肥手术的安全性和有效性外，一些研究人员还证明关键生理和代谢参数（即葡萄糖代谢、高血压、血脂异常等）有显著改善，为手术干预适应症以及多学科青少年特定护理的发展提供了最新的基于共识的指南。尽管结果良好，但儿科和成人人群在获得此类护理方面存在差距。
与以往规模较小且大多为回顾性的系列研究不同，当代研究表明青少年减肥手术耐受性良好且有效。尽管有这些发现以及在多学科护理方面出现了全国性共识，但初级保健提供者仍持怀疑态度，而且在获得医疗服务方面存在重大挑战。需要进行纵向研究并在医学界开展公开对话。
