【摘要】 目的 系统评价治疗青少年重度肥胖3种最常见的手术方式，即可调节胃束带术（AGB）、Roux-en-y胃旁路术（RYGB）、袖状胃切除术（SG）的临床疗效，为临床治疗方案的抉择提供科学依据。方法 计算机检索中国知网（CNKI）、维普（VIP）、万方（WanFang）、中国生物医学文献（CBM）、PubMed、Cochrane Library、Web of Science等数据库，筛选出自建库至2023年4月30日所有关于减重代谢手术（MBS）治疗青少年重度肥胖的研究。采用Jadad量表、MINORS量表和NOS量表进行文献质量评估，结局指标包括体质指数（BMI）、高血压患病率、空腹血糖、空腹胰岛素、甘油三酯和高密度脂蛋白胆固醇水平。采用Stata 17.0软件进行Meta分析。结果 最终筛选出符合纳排标准的研究41项，总样本量为2 092人。Meta分析结果显示，MBS术后重度肥胖青少年BMI明显降低（MD=13.47），其中AGB、RYGB、SG 3种手术后BMI也均明显降低（MD值分别为11.07、14.24和14.93），均有统计学意义（P<0.01），且SG减重效果优于AGB(P<0.01)。术前BMI45.0～<50.0 kg/m~2的青少年MBS后减重效果优于术前BMI 32.5～<45.0 kg/m~2者，差异有统计学意义（t=3.06,P<0.05）；术后平均随访时间10～24个月和>24个月两组之间减重效果差异无统计学意义（F=0.01,P>0.05）。MBS还可降低重度肥胖青少年高血压患病率（OR=0.19,95%CI:0.14～0.26），降低空腹血糖（MD=-0.50）、空腹胰岛素（MD=-21.30）和甘油三酯（MD=-0.53），升高高密度脂蛋白胆固醇水平（MD=0.30），均有统计学意义（P<0.01）。结论 MBS可以持续、有效降低重度肥胖青少年BMI，缓解肥胖相关合并症。相对于AGB,SG手术方式效果更显著。建议重度肥胖青少年在满足手术适应症的条件下，尽早手术以获得更好的减重代谢效果。更多还原

【Abstract】 Objective To evaluate systematically the clinical efficacy of three most common surgical interventions on severe obesity in adolescents,namely adjustable gastric banding(AGB),roux-en-y gastric bypass(RYGB),and sleeve gastrectomy(SG),and provide the scientific evidence for the selection of clinical treatment schemes. Methods The computerized search was conducted in databases including China National Knowledge Infrastructure(CNKI),VIP Database for Chinese Technical Periodicals(VIP),WanFang Data,China Biology Medicine disc(CBM),PubMed,Cochrane Library,Web of Science for identifying the studies on metabolic and bariatric surgery(MBS) treatment of severe obesity in adolescents up to April 30,2023. The literature was assessed using the Jadad scale,MINORS scale,and NOS scale. Outcome indicators included body mass index(BMI),morbidity of hypertension,fasting blood glucose,fasting insulin,triglycerides,and high-density lipoprotein cholesterol levels. Meta-analysis was performed using Stata 17.0 software. Results A total of 41 studies meeting the inclusion and exclusion criteria were identify,the total sample size was 2 092 individuals. The results of the meta-analysis showed that a significant reduction of BMI in severe obese adolescents after MBS(MD=13.47). After AGB,RYGB,and SG,BMI reduced significantly(MD values were 11.07,14.24 and14.93,respectively),P <0.01. The weight loss effect of SG was significantly better than that of AGB(P <0.01). The weight loss outcome after MBS in adolescents with preoperative BMI 45.0 to <50.0 kg/m~2 was significantly better than that in adolescents with preoperative BMI 32.5 to <45.0 kg/m~2(t=3.06,P<0.05). There was no significant difference in weight loss outcomes between the two groups with average following-up times of 10-24 months and >24 months(F =0.01,P >0.05). MBS also might reduce the morbidity of hypertension(OR=0.19,95%CI:0.14-0.26) in severe obese adolescents,and decreased fasting blood glucose(MD=-0.50),fasting insulin(MD=-21.30),and triglycerides(MD=-0.53),while increasing high-density lipoprotein cholesterol levels(MD =0.30),P <0.01. Conclusion MBS can sustainably and effectively reduce BMI in severe obese adolescents,relieve the obesity-related complications. SG surgery is more effective as compared with AGB. It is suggested that severe obese adolescents after meeting the indications of surgery should undergo early operation for getting better metabolic weight loss outcomes.更多还原