Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents A Randomized Trial
Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents A Randomized Trial
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DOI：
10.1001/jama.2010.81
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发表时间：
2010-02-10
影响因子：
120.7
通讯作者：
Dixon, John B.
中科院分区：
文献类型：
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作者：
O'Brien, Paul E.;Sawyer, Susan M.;Dixon, John B.
背景青少年肥胖是一种常见而严重的健康问题，仅在美国就影响着超过500万年轻人。减肥手术正在被评估为一种可能的治疗选择。腹腔镜可调节胃束带术目的比较胃束带与最佳生活方式方案对青少年肥胖的治疗效果。设计、设置和患者一项前瞻性、随机对照试验，纳入50名14 - 18岁体重指数（BMI）高于35的青少年，从澳大利亚墨尔本招募，社区，分配到一个监督的生活方式干预或进行胃束带，并随访2年。该研究于2005年5月至2008年9月进行。次要结果包括代谢综合征，胰岛素抵抗，生活质量和不良outcomes.Results的变化24的25例胃束带组和18的25生活方式组的患者完成了研究。胃束带组中有21例（84%）和生活方式组中有3例（12%）的体重减轻超过50%，经年龄校正。总体而言，胃束带组的平均变化是体重减轻34.6 kg（95% CI，30.2-39.0），表示体重过度减轻78.8%（95% CI，66.6%-91.0%），12.7个BMI单位（95% CI，11.3-14.2），BMI z评分从2.39（95% CI，2.05-2.73）变为1.32（95% CI，0.98-1.66）。生活方式组的平均损失为3.0公斤（95% CI，2.1-8.1），代表体重过度减轻13.2%（95% CI，2.6%-21.0%），1.3个BMI单位（95% CI，0.4-2.9），BMI z评分从2.41（95% CI，2.21-2.66）变为2.26（95% CI，1.91-2.43）。入组时，胃束带组有9名参与者（36%），生活方式组有10名参与者（40%）患有代谢综合征。在24个月时，胃束带组中没有一人出现代谢综合征（P= 0.008; McNemar chi（2）），而生活方式组中18名完成者中有4名（22%）出现代谢综合征（P= 0.13）。胃束带组的生活质量得到改善，无围手术期不良事件。然而，8例手术（33%），需要在7例患者的修订程序，无论是近端袋扩张或管道injury在follow-up.Conclusions肥胖青少年参与者，使用胃束带相比，生活方式干预导致更大的百分比实现了50%的多余重量的损失，纠正年龄。对健康和生活质量有相关的好处。
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 chi(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.