Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, P.R. China.
Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China.
Surg Obes Relat Dis. 2017 Dec;13(12):2037-2055. doi: 10.1016/j.soard.2017.09.516. Epub 2017 Sep 19.
Obesity in adolescents is associated with numerous health risks and co-morbidities, including type 2 diabetes and dyslipidemia. Bariatric surgery on adolescents induces weight loss, but little is known about metabolic effects of these operations.
To explore weight loss and metabolic effects of bariatric surgery on young people.
A systematic review and meta-analysis. University Hospital, China.
PubMed and EMBASE were searched for relevant studies up to July 2017. The related studies in adolescents after operation were included.
A total of 49 studies with 3007 patients were included. The average preoperative age ranged from 13.9 to 19.9 years. Roux-en-Y gastric bypass (n = 1216), laparoscopic adjustable gastric banding (n = 1028), and laparoscopic sleeve gastrectomy (n = 665) were the most common bariatric surgeries performed. At the longest follow-up (range, 12-120 mo), bariatric surgery led to an overall 16.43 kg/m (95% confidence interval [CI]: 14.84-18.01) and 31% (95% CI: 28%-34%) reduction in body mass index. There were significant improvements in glycemic and lipid profiles including glycosylated hemoglobin A1C, fasting blood insulin, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, postoperatively at 12 months. The remission rate of dyslipidemia was 55% (95% CI: 34%-76%), 70% (95% CI: 55%-82%), and 95% (95% CI: 80%-100%) at 1, 3, and>5 years after surgery. Roux-en-Y gastric bypass produced better improvements than other surgical procedures.
Bariatric surgery in adolescents may achieve significant weight loss, and glycemic and lipid control. Further well-designed studies with longer follow-up are warranted to provide more reliable evidence.
青少年肥胖与许多健康风险和合并症有关，包括 2 型糖尿病和血脂异常。青少年的减肥手术可诱导体重减轻，但对这些手术的代谢影响知之甚少。
探讨减肥手术对年轻人的减肥效果和代谢影响。
系统评价和荟萃分析。中国大学医院。
检索至 2017 年 7 月的相关文献。包括术后青少年的相关研究。
共纳入 49 项研究，3007 例患者。平均术前年龄为 13.9-19.9 岁。最常见的减肥手术是 Roux-en-Y 胃旁路术（n=1216）、腹腔镜可调胃束带术（n=1028）和腹腔镜袖状胃切除术（n=665）。在最长随访时间（范围为 12-120 个月），减肥手术后总体体重指数（BMI）降低了 16.43kg/m（95%置信区间：14.84-18.01），降低了 31%（95%置信区间：28%-34%）。术后 12 个月，血糖和血脂谱包括糖化血红蛋白 A1C、空腹血胰岛素、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇均有显著改善。手术后 1、3 和>5 年，血脂异常的缓解率分别为 55%（95%置信区间：34%-76%）、70%（95%置信区间：55%-82%）和 95%（95%置信区间：80%-100%）。Roux-en-Y 胃旁路术比其他手术方式改善效果更好。
青少年减肥手术可能实现显著的体重减轻和血糖及血脂控制。需要进一步进行设计良好、随访时间更长的研究，以提供更可靠的证据。
