Department of pediatric endocrinology and diabetology, university hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
Department of pediatric endocrinology and diabetology, university hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
Ann Endocrinol (Paris). 2017 Oct;78(5):462-468. doi: 10.1016/j.ando.2017.03.002. Epub 2017 Sep 1.
Severe obesity (body mass index>120% of BMI IOTF-30 cut off) and morbid obesity (BMI>140% of BMI IOTF-30 cut off) affect 5 to 10% of obese adolescents in France. Organic complications can be found in about 50% of these patients, and depressive symptoms in one-third of them. Finally, over 70% will suffer from adult morbid obesity associated with a marked increase in morbidity and mortality. However, the reversion of obesity strongly decreases, and may even cancels, these risks. In controlled randomized studies, lifestyle interventions have limited effectiveness on BMI in children (and none in adolescents). Bariatric surgery has been shown to have short-term effectiveness in adolescents with severe and morbid obesity: the average BMI loss after gastric banding was 11.6kg/m (95% confidence interval from 9.8 to 13.4), 16.6kg/m (95% confidence interval from 13.4 to 19.8) after bypass, and 14.1kg/m (95% confidence interval 10.8 to 17.5) after sleeve gastrectomy. The resolution of comorbidities was the main aim, as well as the improvement of quality of life. This is not a simple surgical intervention, and minor side effects have been reported in approximately 10-15% of teenagers who underwent surgery (more common with the gastric band), and severe side effects in nearly 1-5% (mainly with bypass). In France, recommendations regarding indications, the care pathway, multidisciplinary meetings, reference management structures and postoperative care have been published by the French National Health Authority (HAS) in 2016 to provide a framework for bariatric surgery in underage patients.
在法国，严重肥胖（身体质量指数>120%的 IOTF-30 截断值）和病态肥胖（BMI>140%的 IOTF-30 截断值）影响了 5%至 10%的肥胖青少年。这些患者中约有 50%存在器官并发症，三分之一存在抑郁症状。最后，超过 70%的人会患上与发病率和死亡率显著增加相关的成年病态肥胖。然而，肥胖的逆转率大大降低，甚至可能消除这些风险。在对照随机研究中，生活方式干预对儿童的 BMI 影响有限（对青少年则没有影响）。减重手术已被证明对严重和病态肥胖的青少年具有短期效果：胃带手术后平均 BMI 降低 11.6kg/m（95%置信区间为 9.8 至 13.4），旁路手术后为 16.6kg/m（95%置信区间为 13.4 至 19.8），袖状胃切除术后为 14.1kg/m（95%置信区间为 10.8 至 17.5）。主要目标是解决合并症，并提高生活质量。这不是一个简单的手术干预，约有 10-15%接受手术的青少年（胃带更常见）和近 1-5%的青少年（主要是旁路）报告出现轻微副作用，近 1-5%的青少年报告出现严重副作用。2016 年，法国国家卫生署（HAS）发布了有关未成年患者减重手术适应证、护理路径、多学科会议、参考管理结构和术后护理的建议，为未成年患者的减重手术提供了框架。
