随着青少年肥胖发病率的持续上升，减重代谢手术在改善体重与合并症方面显示出明确且可持续的临床获益，但围绕青少年手术伦理决策、成长发育以及医疗公平性等方面仍存在争议。建议采用“伦理-临床一体化”决策框架，即：以“四原则”为轴，落实家长许可+患儿同意；将适应证由“唯BMI”转为表型和风险驱动，强调多学科综合治疗协作组评估和围手术期管理；构建成长与骨健康、营养与心理的长期随访和风险预案；主张对BMI≥同龄同性第95百分位数的140%或有严重并发症者尽早转诊评估，将胃袖状切除术和Roux-en-Y胃旁路手术作为优选；同时，以公正可及为目标，规范转诊与支付路径，减少污名与延迟。此举可在确保安全前提下最大化净获益，提升青少年肥胖治疗的规范性与可及性。
Abstract
With the rise of adolescent obesity, metabolic and bariatric surgery (MBS) yields clear and durable improvements in weight and comorbidities; however, ethical decision-making, growth and development, and healthcare equity remain contested. We propose an “ethics-clinical integrated” framework: (1) anchor decisions in the four principles, operationalized as parental permission plus adolescent assent; (2) shift indications from BMI-only to phenotype- and risk-driven criteria, supported by multidisciplinary team (MDT) assessment and standardized perioperative management; (3) implement long-term surveillance plans for growth/bone health, nutrition, and psychological well-being, with predefined risk-mitigation strategies. We advocate early referral for evaluation when BMI ≥140% of the 95th percentile or when severe obesity-related complications are present, prioritizing sleeve gastrectomy or Roux-en-Y gastric bypass as preferred options where appropriate. To promote justice and access, we recommend standardized referral and payment pathways and active reduction of stigma and delays. This framework aims to maximize net benefit while ensuring safety, thereby enhancing the standardization and accessibility of MBS for adolescents.
关键词
青少年 /
减重代谢手术 /
伦理 /
临床决策 /
生长发育
Key words
adolescent /
metabolic and bariatric surgery /
ethic /
clinical decision /
growth
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参考文献
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