Till Holger, Mann Oliver, Singer Georg, Weihrauch-Blüher Susann
Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8036 Graz, Austria.
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
Children (Basel). 2021 May 9;8(5):372. doi: 10.3390/children8050372.
Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.
尽管受到全球公众关注并付出了巨大医疗努力，但儿童和青少年严重病态肥胖的患病率仍在上升。与成年人一样，过多的脂肪组织会触发多种免疫和代谢途径，导致严重的合并症，如糖耐量受损甚至2型糖尿病（T2D）、血脂异常、动脉高血压、非酒精性脂肪肝病和高尿酸血症。严重儿童肥胖的管理需要终生的多学科方法，结合生活方式改变、营养和药物治疗。标准化的生活方式干预计划仍然是病态肥胖儿童和青少年的一线治疗方法，但遗憾的是，长期成功率有限。在这种情况下，代谢性减肥手术（MBS）已从一个有争议的问题发展到被纳入明确的建议中。根据美国代谢与减肥外科学会（ASMBS）儿科委员会的说法，青少年减肥手术的适应症必须遵循非常严格的标准。患有II类肥胖（BMI>第95百分位数的120%）且已确诊合并症的青少年或患有III类肥胖（BMI≥第95百分位数的140%）的青少年应考虑进行MBS。这些干预措施属于高风险手术，青少年应在配备长期随访计划的专业、多学科大容量肥胖中心接受治疗。Roux-en-Y胃旁路术（RYGB）仍然是所有吸收不良手术的金标准。作者于2008年率先将腹腔镜袖状胃切除术（LSG）作为病态肥胖青少年的独立手术，目前已成为病态肥胖青少年最常进行的手术。最近的文献证明，MBS在病态肥胖青少年中是安全有效的。中期数据显示主要合并症有显著改善甚至缓解。因此，用于治疗病态肥胖青少年的MBS已从一个有争议的问题发展到被几个医学协会纳入明确建议，作为一种治疗策略，以减少可能在成年期导致终末器官损害的严重合并症。
