切换至 "中华医学电子期刊资源库"

中华肥胖与代谢病电子杂志 ›› 2019, Vol. 05 ›› Issue (01) : 3 -9. doi: 10.3877/cma.j.issn.2095-9605.2019.01.001

所属专题: 指南与规范 文献 指南共识

指南

中国儿童和青少年肥胖症外科治疗指南(2019版)
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会   
  • 出版日期:2019-02-28

The clinical guideline for surgical treatment of childhood and adolescent obesity in China (2019 Edition)

Chinese Society for Metabolic and Bariatric Surgery   

  • Published:2019-02-28
引用本文:

中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国儿童和青少年肥胖症外科治疗指南(2019版)[J]. 中华肥胖与代谢病电子杂志, 2019, 05(01): 3-9.

Chinese Society for Metabolic and Bariatric Surgery. The clinical guideline for surgical treatment of childhood and adolescent obesity in China (2019 Edition)[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2019, 05(01): 3-9.

近年来,中国儿童和青少年的肥胖症患病率迅猛增加。肥胖症可以引发2型糖尿病、高血压病、高脂血症、高尿酸血症等一系列代谢紊乱性疾病。饮食控制、体育锻炼及现有的药物等对儿童和青少年肥胖症的治疗效果并不确切,越来越多的循证医学证据表明减肥手术能显著减轻肥胖症儿童青少年的体重,并缓解肥胖相关的代谢病。随着减重代谢外科在我国的快速普及,中国肥胖儿童和青少年选择减肥手术治疗肥胖症的例数逐渐增多,但仍缺少相应的基于临床研究证据的诊疗规范。因此,中国医师协会外科医师分会肥胖和糖尿病外科医师委员会于2018年6月发起编写首版《中国儿童和青少年肥胖症外科治疗指南》,旨在为该领域临床医生的临床决策提供参考依据,同时鼓励针对此临床问题进行深入的研究,以期积累国人特征的循证医学证据,为中国儿童和青少年肥胖症外科治疗的临床决策提供更高级别的证据。

[1]
GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years[J]. N Engl J Med, 2017, 377(1):13-27.
[2]
Gregg EW, Shaw JE. Global Health Effects of Overweight and Obesity[J]. N Engl J Med, 2017, 377(1):80-81.
[3]
马冠生. 中国儿童肥胖报告[M]. 北京: 人民卫生出版社, 2017: 5-29.
[4]
盛秋明,李卫国,张海涛, 等.超重肥胖儿童青少年代谢综合征流行现状调查[J]. 临床儿科杂志, 2009, 27(04):359-362.
[5]
叶佩玉,陈芳芳,米杰. 儿童期肥胖的健康危害:来自中国人群的证据[J]. 中华预防医学杂志, 2016(1):97-100.
[6]
吴溢,李敬东,祝顺萍, 等. 青少年肥胖症的危害和治疗现状[J]. 中华肥胖与代谢电子杂志, 2017, 3(02):70-73.
[7]
Baker JL, Olsen LW, Sørensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood[J]. N Engl J Med, 2007, 357(23):2329-2337.
[8]
Bibbins-Domingo K, Coxson P, Pletcher MJ, et al. Adolescent overweight and future adult coronary heart disease[J]. N Engl J Med, 2007, 357(23):2371-2379.
[9]
Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935[J]. N Engl J Med, 1992, 327(19):1350-1355.
[10]
Must A, Phillips SM, Naumova EN. Occurrence and timing of childhood overweight and mortality: findings from the Third Harvard Growth Study[J]. J Pediatr, 2012, 160(5):743-750.
[11]
NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults[J]. Lancet, 2017, 390(10113):2627-2642.
[12]
Hales CM, Fryar CD, Carroll MD, et al. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016[J]. JAMA, 2018, 319(16):1723-1725.
[13]
Bussler S, Penke M, Flemming G, et al. Novel Insights in the Metabolic Syndrome in Childhood and Adolescence[J]. Horm Res Paediatr, 2017, 88(3-4):181-193.
[14]
Inge TH, Courcoulas AP, Jenkins TM, et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents[J]. N Engl J Med, 2016, 374(2):113-123.
[15]
Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association[J]. Circulation, 2013, 128(15):1689-1712.
[16]
Savoye M, Nowicka P, Shaw M, et al. Long-term results of an obesity program in an ethnically diverse pediatric population[J]. Pediatrics, 2011, 127(3):402-410.
[17]
Danielsson P, Kowalski J, Ekblom Ö, et al. Response of severely obese children and adolescents to behavioral treatment[J]. Arch PediatrAdolesc Med, 2012, 166(12):1103-1108.
[18]
Kalarchian MA, Levine MD, Arslanian SA, et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial[J]. Pediatrics, 2009, 124(4):1060-1068.
[19]
Copeland KC, Silverstein J, Moore KR, et al. Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents[J]. Pediatrics, 2013, 131(2):364-382.
[20]
Stavra A Xanthakos, Thomas H Inge, Daniel Jones, et al. Surgical management of severe obesity in adolescents[EB/OL]. [2018-08-15].

URL    
[21]
Pratt J, Browne A, Browne NT, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018[J]. Surg Obes Relat Dis, 2018, 14(7):882-901.
[22]
Mirianm E, Tucker. New Guidelines Address Bariatric Surgery in Children[EB/OL]. [2018-08-15].

URL    
[23]
中华人民共和国全国人民代表大会常务委员会. 中华人民共和国未成年人保护法[Z]. 1991-09-04.
[24]
Bäckström K. Convention on the rights of the child[J]. International Journal of Early Childhood, 1989, 21(2):35-44.
[25]
陈春明. 中国学龄儿童少年超重和肥胖预防与控制指南[M]. 北京: 人民卫生出版社, 2008.
[26]
Mohaidly MA, Suliman A, Malawi H. Laparoscopic sleeve gastrectomy for a two-and half year old morbidly obese child[J]. Int J Surg Case Rep, 2013, 4(11):1057-1060.
[27]
Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association[J]. Circulation, 2013, 128(15):1689-1712.
[28]
李辉,宗心南,季成叶, 等. 中国2-18岁儿童青少年超重和肥胖筛查体重指数界值点的研究[J]. 中华流行病学杂志, 2010, 31(6):616-620.
[29]
Silber T, Randolph J, Robbins S. Long-term morbidity and mortality in morbidly obese adolescents after jejunoileal bypass[J]. J Pediatr, 1986, 108(2):318-322.
[30]
Lebedev LV, SedletskiĭIuI, Koreshkin IA, et al. 5- to 12-year results of surgical treatment of patients with extreme forms of obesity[J]. VestnKhirIm I I Grek, 1990, 145(8):116-118.
[31]
Tsai WS, Inge TH, Burd RS. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome[J]. Arch Pediatr Adolesc Med, 2007, 161(3):217-221.
[32]
Zwintscher NP, Azarow KS, Horton JD, et al. The increasing incidence of adolescent bariatric surgery[J]. J Pediatr Surg, 2013, 48(12):2401-2407.
[33]
周湘茂,杨华,杨景哥, 等. 精准肥胖与代谢病外科手术在肥胖青少年中的应用经验[J]. 糖尿病天地(临床), 2015, 9(3):156-160.
[34]
Varela JE, Hinojosa MW, Nguyen NT. Perioperative outcomes of bariatric surgery in adolescents compared with adults at academic medical centers[J]. Surg Obes Relat Dis, 2007, 3(5):537-540.
[35]
Kelleher DC, Merrill CT, Cottrell LT, et al. Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009[J]. JAMA Pediatr, 2013, 167(2):126-132.
[36]
Sarkhosh, Birch DW, Sharma A, et al. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide[J]. Can J Surg, 2013, 56(5):347-352.
[37]
Sugerman HJ, Sugerman EL, DeMaria EJ, et al. Bariatric surgery for severely obese adolescents[J]. J Gastrointest Surg, 2003, 7(1):102-108.
[38]
Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal[J]. J Clin Endocrinol Metab, 2007, 92(12):4678-4685.
[39]
Kaulfers AM, Bean JA, Inge TH, et al. Bone loss in adolescents after bariatric surgery[J]. Pediatrics, 2011, 127(4):e956-e961.
[40]
Alqahtani AR, Antonisamy B, Alamri H, et al. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years[J]. Ann Surg, 256(2):266-273.
[41]
Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery[J]. N Engl J Med, 2005, 353(3):249-254.
[42]
Inge TH, Courcoulas AP, Jenkins TM, et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents[J]. N Engl J Med, 2016, 374(2):113-123.
[43]
Paulus GF, de Vaan LE, Verdam FJ, et al. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis[J]. Obes Surg, 2015, 25(5):860-878.
[44]
Kalra M, Inge T, Garcia V, et al. Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery[J]. Obes Res, 2005, 13(7):1175-1179.
[45]
Inge TH, Miyano G, Bean J, et al. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents[J]. Pediatrics, 2009, 123(1):214-222.
[46]
Messiah SE, Lopez-Mitnik G, Winegar D, et al. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database[J]. Surg Obes Relat Dis, 2013, 9(4):503-513.
[47]
Lawson ML, Kirk S, Mitchell T, et al. One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group[J]. J Pediatr Surg, 2006, 41(1):137-143.
[48]
Loux TJ, Haricharan RN, Clements RH, et al. Health-related quality of life before and after bariatric surgery in adolescents[J]. J Pediatr Surg, 2008, 43(7):1275-1279.
[49]
Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease[J]. Gastroenterology, 2009, 137(2):532-540.
[50]
Loy JJ, Youn HA, Schwack B, et al. Improvement in nonalcoholic fatty liver disease and metabolic syndrome in adolescents undergoing bariatric surgery[J]. Surg Obes Relat Dis, 2015, 11(2):442-449.
[51]
Corey KE, Vuppalanchi R, Vos M, et al. Improvement in liver histology is associated with reduction in dyslipidemia in children with nonalcoholic fatty liver disease[J]. J Pediatr Gastroenterol Nutr, 2015, 60(3):360-367.
[52]
Inge TH, Prigeon RL, Elder DA, et al. Insulin Sensitivity and β-Cell Function Improve after Gastric Bypass in Severely Obese Adolescents[J]. J Pediatr, 2015, 167(5):1042-1048.
[53]
Khidir N, El-Matbouly MA, Sargsyan D, et al. Five-year Outcomes of Laparoscopic Sleeve Gastrectomy: a Comparison Between Adults and Adolescents[J]. Obes Surg, 2018, 28(7):2040-2045.
[54]
Dymek MP, le Grange D, Neven K, et al. Quality of life and psychosocial adjustment in patients after Roux-en-Y gastric bypass: a brief report[J]. Obes Surg, 2001, 11(1):32-39.
[55]
Inge TH, Coley RY, Bazzano LA, et al. Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study[J]. Surg Obes Relat Dis, 2018, 14(9):1386-1388.
[56]
Altieri MS, Pryor A, Bates A, et al. Bariatric procedures in adolescents are safe in accredited centers[J]. Surg Obes Relat Dis, 2018, 14(9):1372-1373.
[57]
Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study[J]. JAMA Pediatr, 2014, 168(1):47-53.
[58]
Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. American Society for Metabolic and Bariatric Surgery position statement on emergency care of patients with complications related to bariatric surgery[J]. Surg Obes Relat Dis, 2010, 6(2):115-117.
[59]
White B, Doyle J, Colville S, et al. Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success[J]. Clin Obes, 2015, 5(6):312-324.
[60]
O'Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial[J]. JAMA, 2010, 303(6):519-526.
[61]
Messiah SE, Lopez-Mitnik G, Winegar D, et al. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database[J]. Surg Obes Relat Dis, 2013, 9(4):503-513.
[62]
Holterman AX, Browne A, Tussing L, et al. A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes[J]. J Pediatr Surg, 2010, 45(1):74-78.
[63]
Jen HC, Rickard DG, Shew SB, et al. Trends and outcomes of adolescent bariatric surgery in California, 2005-2007[J]. Pediatrics, 2010, 126(4):e746-e753.
[64]
Inge TH. Assessing and Selecting Patients for Bariatric Surgery[M]/ Endocrine Surgery in Children. 2018.
[65]
Neff KJ, Olbers T, le Roux CW. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes[J]. BMC Med, 2013, 11:8.
[66]
Pratt JSA, Browne A, Browne NT, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018[J]. Surg Obes Relat Dis, 2018, 14(7):882-901.
[67]
Tseng EK, Kolesar E, Handa P, et al. Weight-Adjusted Tinzaparin for the prevention of Venous Thromboembolism after Bariatric Surgery[J]. J Thromb Haemost, 2018.
[68]
Nutrition and Metabolism Collaboration of Chinese Society for Parenteral and Enteral Nutrition. The consensus on nutritional and multi-disciplinary management for bariatric surgery[J]. Zhonghua wai ke za zhi [Chinese journal of surgery], 2018, 56(2):81.
[69]
王存川. 肥胖与代谢病外科学[M]. 北京: 人民卫生出版社, 2015: 243-245.
[70]
Gimenes JC, Nicoletti CF, de Souza Pinhel MA, et al. Pregnancy After Roux en Y Gastric Bypass: Nutritional and Biochemical Aspects[J]. Obes Surg, 2017, 27(7):1815-1821.
[71]
Holt VL, Cushing-Haugen KL, Daling JR. Body weight and risk of oral contraceptive failure[J]. Obstet Gynecol, 2002, 99(5 Pt 1):820-827.
[72]
Holt VL, Scholes D, Wicklund KG, et al. Body mass index, weight, and oral contraceptive failure risk[J]. Obstet Gynecol, 2005, 105(1):46-52.
[73]
Zieman M, Guillebaud J, Weisberg E, et al. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data[J]. Fertil Steril, 2002, 77(2 Suppl 2):S13-18.
[1] 刘静, 王燕妮, 王继萍. 儿童毛发移植应用前景及病例讨论[J]. 中华损伤与修复杂志(电子版), 2024, 19(04): 368-368.
[2] 张梦思, 麻艺群, 蒙礼娟, 朱辉, 付晋凤. 压力手套与指蹼加压带及泡沫型硅凝胶贴膜联合应用于儿童瘢痕性并指术后的效果观察[J]. 中华损伤与修复杂志(电子版), 2024, 19(04): 329-334.
[3] 陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[4] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南(2024版)[J]. 中华普通外科学文献(电子版), 2024, 18(04): 241-252.
[5] 王宇, 徐芳泉, 周旋, 姚晓峰, 李强. 不断提高分化型甲状腺癌根治性切除规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 473-476.
[6] 吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[7] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[8] 高晓峰, 朱士博, 周锐, 唐向亮, 李典, 束方鹏, 赵天鑫, 贾炜, 刘国昌, 伏雯. 吲哚菁绿在腹腔镜下保留淋巴管治疗青少年精索静脉曲张中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 232-236.
[9] 曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243.
[10] 中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[11] 刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[12] 中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 407-449.
[13] 郑以山, 颜骏, 刘军. 《ICU中成人急性肝衰竭和急性-慢性肝衰竭的管理指南:神经病学、围移植期医学、感染性疾病和胃肠病学注意事项》解读[J]. 中华重症医学电子杂志, 2024, 10(03): 214-217.
[14] 梁艳娉, 陈燕柔, 梁运啸, 白飞虎, 吴斌, 王省. 华南地区门静脉高压食管胃静脉曲张出血内镜治疗现状调研分析[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 390-395.
[15] 王晓瑜, 郭群英, 牛雅萌, 赵成松. 公立儿童医院促进儿科就医均等化实践探析[J]. 中华临床医师杂志(电子版), 2024, 18(04): 383-387.
阅读次数
全文


摘要