据2月10日刊JAMA上的一则研究披露,有较高百分比的罹患严重肥胖症的青少年在接受了腹腔镜可调节胃束带手术后减掉了50%以上的多余体重,他们所感受到的健康上的裨益和生活质量改善比那些参加强化生活方式管理计划的人要更多。
青少年肥胖症是一个世界性的严重的健康挑战。在美国,有超过17.4%(或5百万以上)的青少年在2004年的时候患有肥胖症,该数字与2000年时的14.8%相比又有了增加。根据文章的背景资料,肥胖症与即刻的以及迟发的健康损害都有关系,而且还会减少人的寿命。生活方式干预计划包括了变更饮食、锻炼以及采取促进减重的行为,但它们的结果通常很差。文章的作者写道:“减肥外科手术现在已在成年人中广泛使用,现在,这种手术正在青少年中进行评估。腹腔镜可调节胃束带手术有可能提供人们一种安全有效的治疗方法。”
Monash University, Melbourne, Australia的Paul E. O’Brien, M.D., F.R.A.C.S.及其同僚开展了一项研究,旨在检查胃束带术是否能够比目前所用的生活方式管理的方法带来更多的减重、更大的健康裨益及更好地改善患有严重肥胖症的青少年的生活品质。这一随机化且设有对照的试验中包括了50名年龄在14-18岁之间的身体质量指数(BMI)高于35的青少年,他们被分配加入到一个有人督导的生活方式管理小组或是接受胃束带术的小组,这些人都接受了为期长达2年的随访。生活方式管理计划包括:减少热卡的摄入、增加运动量以及行为修正。该项研究是在2005年5月至2008年9月间进行的。在25位接受胃束带术的患者中有24人完成了该项研究,而25名接受生活方式干预的患者中有18人完成了该项研究。
研究人员发现,初步的结果显示,在25名接受胃束带术的患者中,有21人(占84%)减去了超过50%的多余体重,而在生活方式干预组的25人中,只有3人达到了这个水平(占12%)。在2年之后,胃束带术组的人平均减掉的体重约为76磅,相当于总的来说平均减掉了28.3%的总体重及78.8%的多余体重。生活方式干预组的人所减掉的体重平均为6.6磅,这相当于平均减去了3.1%的总体重及13.2%的多余体重。在第24个月的时候,这2个组之间的差别在所有的体重测量方式上都是显著的。
文章的作者写道:“在患者刚加入这项研究的时候,在胃束带术组中有9个人(占36%)有代谢综合症,而在生活方式干预组中,有该综合症的人有10个(占40%)。在24个月的时候,在胃束带术组中已经没有一个人患有代谢综合症,而在生活方式干预组中的18位完成研究的人中有4人(占22%)患有代谢综合症。”在胃束带术组的患者中,他们感到生活品质有所改善,并在术后的短时间中没有出现不良反应事件。但是,在该手术组中,有7人需要进行8次的修正性术疗(占33%)。
研究人员得出结论:“青少年及其他们的家长必须懂得认真坚持所建议的饮食行为的重要性,且如果出现了胃酸反流、胃灼热或呕吐时应及早咨询医生。同样重要的是,他们应该处在一种能够保持与懂得护理过程的医务人员进行接触的环境之中。”
推荐原始出处:
JAMA. 2010;303(6):519-526.
Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents
A Randomized Trial
Paul E. O’Brien, MD, FRACS; Susan M. Sawyer, MBBS, MD, FRACP; Cheryl Laurie, RN, BHSc; Wendy A. Brown, MBBS, PhD, FRACS; Stewart Skinner, MBBS, PhD, FRACS; Friederike Veit, MBBS, MD, FRACP; Eldho Paul, MSc; Paul R. Burton, MBBS, FRACS; Melanie McGrice, BSc, M Nutr Diet; Margaret Anderson, BHIM, Grad Dip HA; John B. Dixon, MBBS, PhD, FRACGP
Context Adolescent obesity is a common and serious health problem affecting more than 5 million young people in the United States alone. Bariatric surgery is being evaluated as a possible treatment option. Laparoscopic adjustable gastric banding (gastric banding) has the potential to provide a safe and effective treatment.
Objective To compare the outcomes of gastric banding with an optimal lifestyle program on adolescent obesity.
Design, Setting, and Patients A prospective, randomized controlled trial of 50 adolescents between 14 and 18 years with a body mass index (BMI) higher than 35, recruited from the Melbourne, Australia, community, assigned either to a supervised lifestyle intervention or to undergo gastric banding, and followed up for 2 years. The study was performed between May 2005 and September 2008.
Main Outcome Measures Weight loss. Secondary outcomes included change in metabolic syndrome, insulin resistance, quality of life, and adverse outcomes.
Results Twenty-four of 25 patients in the gastric banding group and 18 of 25 in lifestyle group completed the study. Twenty-one (84%) in the gastric banding and 3 (12%) in the lifestyle groups lost more than 50% of excess weight, corrected for age. Overall, the mean changes in the gastric banding group were a weight loss of 34.6 kg (95% CI, 30.2-39.0), representing an excess weight loss of 78.8% (95% CI, 66.6%-91.0%), 12.7 BMI units (95% CI, 11.3-14.2), and a BMI z score change from 2.39 (95% CI, 2.05-2.73) to 1.32 (95% CI, 0.98-1.66). The mean losses in the lifestyle group were 3.0 kg (95% CI, 2.1-8.1), representing excess weight loss of 13.2% (95% CI, 2.6%-21.0%), 1.3 BMI units (95% CI, 0.4-2.9), and a BMI z score change from 2.41 (95% CI, 2.21-2.66) to 2.26 (95% CI, 1.91-2.43). At entry, 9 participants (36%) in the gastric banding group and 10 (40%) in the lifestyle group had the metabolic syndrome. At 24 months, none of the gastric banding group had the metabolic syndrome (P = .008; McNemar 2) compared with 4 of the 18 completers (22%) in the lifestyle group (P = .13). The gastric banding group experienced improved quality of life with no perioperative adverse events. However, 8 operations (33%) were required in 7 patients for revisional procedures either for proximal pouch dilatation or tubing injury during follow-up.
Conclusions Among obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage achieving a loss of 50% of excess weight, corrected for age. There were associated benefits to health and quality of life.