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南京医科大学学报(自然科学版) 第42卷第10期
·1482 · Journal of Nanjing Medical University(Natural Sciences) 2022年10月
·综 述·
儿童青少年肥胖病代谢手术应用进展
韩 涛,冯文焕 *
南京医科大学鼓楼临床医学院内分泌科,江苏 南京 210008
[摘 要] 我国儿童青少年肥胖患者迅速增加,合并多种肥胖并发症,增加成年后肥胖及相关并发症发病风险,减少预期寿
命。目前国内尚无药物批准用于儿童青少年减重治疗,代谢手术是生活方式干预无效的中重度肥胖儿童青少年患者可选用的
减重措施。国内外研究显示,此类人群代谢术后,有效减重,改善、逆转2型糖尿病、高脂血症、高血压等肥胖相关并发症,围手
术期并发症发生率与成人类似,术后补充和监测营养元素利于减少远期营养不良相关并发症,同时需关注患者的精神心理状
态。本文综述国内外儿童青少年代谢手术开展情况、手术适应证、禁忌证、术式及随访要求。
[关键词] 代谢手术;儿童青少年;肥胖病
[中图分类号] R589.2 [文献标志码] A [文章编号] 1007⁃4368(2022)10⁃1482⁃06
doi:10.7655/NYDXBNS20221022
Progress of metabolic surgery in children and adolescents with obesity
HAN Tao,FENG Wenhuan *
Department of Endocrinology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing
210008,China
[Abstract] Obesity is increasing rapidly among children and adolescents in China,which is associated with multiple obesity
complications,the risk of obesity and related complications in adulthood,and reduction of life expectancy. Nowadays,no medication is
approved for weight loss in children and adolescents in China. Metabolic surgery has been considered as weight loss treatment for
children and adolescents with moderate to severe obesity when lifestyle interventions are ineffective. Studies in China and other
countries have shown that children and adolescents with moderate and severe obesity achieved substantial weight loss after metabolic
surgery,accompanied with improvement,even reversal of obesity ⁃ related complications such as type 2 diabetes,dyslipidemia and
hypertension,etc. and similar perioperative complication as adults. Postoperative appropriate nutrient supplement and monitoring are
beneficial to reduce the long⁃term malnutrition complications,and patients’mental health also need to be monitored. This article
reviewed the development of metabolic surgery in children and adolescents in China and abroad,and also indications,
contraindications,surgical procedures and follow⁃up requirements.
[Key words] metabolic surgery;children and adolescents;obesity
[J Nanjing Med Univ,2022,42(10):1482⁃1487]
全球儿童青少年肥胖患病率近十余年来迅猛 0.7% 增至5.6% 。2002—2012年,我国6~17岁儿童
[1]
增长 [1-2] 。相较于1975年,2016 年全球5~19 岁男性 青少年超重占比由 4.5%增至 9.6%,肥胖占比由
儿童青少年肥胖患病率由 0.9% 增至 7.8%,女性由 2.1%增至 6.4%,2017 年北京中小学超重率达到
[2]
15.9%,肥胖患病率16.9%,已与美国持平 。
研究显示儿童青少年肥胖危害不亚于成人,该
[ 基 金 项 目 ] 江 苏 省 自 然 科 学 基 金 面 上 项 目
人群体重指数(body mass index,BMI)每增加 5 个单
(BK20201115);中华国际交流基金会森美中华糖尿病科研
基金(Z-2017-26-1902) 位,空腹血糖水平受损和高血压风险分别增加15%
[3]
∗
通信作者(Corresponding author),E⁃mail:fengwh501@163.com 和 10% ,同时增加非酒精性脂肪肝(non⁃alcoholic