2024+HKSMBS立场声明:成人肥胖减重和代谢手术以及内镜手术的资格标准建议.pdf
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1、1Hong Kong Medical Journal 2024 Hong Kong Academy of Medicine.All rights reservedA B S T R A C T The surgical management of obesity in Hong Kong has rapidly evolved over the past 20 years.Despite increasing public awareness and demand concerning bariatric and metabolic surgery,service models general
2、ly are not standardised across bariatric practitioners.Therefore,a working group was commissioned by the Hong Kong Society for Metabolic and Bariatric Surgery to review relevant literature and provide recommendations concerning eligibility criteria for bariatric and metabolic interventions within th
3、e local population in Hong Kong.The current position statement aims to provide updated guidance regarding the indications and contraindications for bariatric surgery,metabolic surgery,and bariatric endoscopic procedures.Recommendations for eligibility criteria concerning bariatric and metabolic surg
4、ical and endoscopic procedures for obese Hong Kong adults 2024:Hong Kong Society for Metabolic and Bariatric Surgery Position StatementShirley YW Liu,Carol MS Lai,Enders KW Ng,Fion SY Chan,SK Leung,Wilfred LM Mui,Daniel KH Tong,Dennis CT Wong,Patricia PC Yam,Simon KH Wong*Obesity is a complex multif
5、actorial disease caused by diverse combinations of genetic,behavioural,environmental,and endocrine aetiologies.In 2013,obesity was recognised by the American Medical Association as a disease state requiring treatment and prevention efforts.1 Obesity substantially increases an individuals risks of ca
6、rdiovascular diseases,metabolic illnesses,musculoskeletal problems,and cancer.For healthcare policymakers,the financial burden of treating and preventing obesity and its related conditions is exponentially growing.At the community level,reduced workforce productivity from obesity-related adverse hea
7、lth outcomes can lead to detrimental impacts on the broader economy.According to the World Health Organization,adults are considered overweight when their body mass index(BMI)is 25 kg/m2 and obese when their BMI is 30 kg/m2.2 However,Asian populations have a higher percentage of body fat and greater
8、 metabolic risk at lower BMIs.3 A World Health Organization expert consultation identified potential public health action points for Asians as 23.0 kg/m2,27.5 kg/m2,Hong Kong Med J 2024;30:Epubhttps:/doi.org/10.12809/hkmj22106561 SYW Liu,FRCS,FHKAM(Surgery)1 CMS Lai,FRCS,FHKAM(Surgery)1 EKW Ng,FRCS,
9、FHKAM(Surgery)2 FSY Chan,FRCS,FHKAM(Surgery)3 SK Leung,FRCS,FHKAM(Surgery)4 WLM Mui,FRCS,FHKAM(Surgery)5 DKH Tong,FRACS,FHKAM(Surgery)6 DCT Wong,FRACS,FHKAM(Surgery)3 PPC Yam,FRCS,FHKAM(Surgery)1 SKH Wong*,FRCS,FHKAM(Surgery)1 Department of Surgery,Prince of Wales Hospital,Faculty of Medicine,The Ch
10、inese University of Hong Kong,Hong Kong SAR,China2 Department of Surgery,Queen Mary Hospital,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong SAR,China3 Department of Surgery,Tuen Mun Hospital,Hong Kong SAR,China4 Hong Kong Bariatric and Metabolic Institute,Hong Kong SAR,China5
11、Hong Kong Sanatorium&Hospital,Hong Kong SAR,China6 St Teresas Hospital,Hong Kong SAR,China*Corresponding author:wongkhmosurgery.cuhk.edu.hk32.5 kg/m2,and 37.5 kg/m2;these values generally were 2.5 kg/m2 lower than the thresholds established for Caucasians.4 Because of differences in body frame and v
12、isceral fat distribution,lower BMI thresholds were used to define overweight(23 kg/m2)and obesity(25 kg/m2)in Asians.3 Similar to other regions of the world,obesity is a substantial public health problem in Hong Kong.5 According to the latest Population Health Survey 2020/22 conducted by the Departm
13、ent of Health,the prevalences of obesity and overweight in people aged 15 to 84 years were 32.6%and 22.0%,respectively.6 These prevalences indicate that at least half of the local Hong Kong population faces health risks associated with overweight or obesity.Bariatric and metabolic surgeryBariatric s
14、urgery(ie,surgical treatment for obesity)has been continuously evolving worldwide over the past 50 years,with increasingly diverse procedural options and indications.7 In 1991,the National MEDICAL PRACTICEThis article was published on 3 Jun 2024 at www.hkmj.org.This version may differ from the print
15、 version.#Liu et al#2Hong Kong Medical Journal 2024 Hong Kong Academy of Medicine.All rights reserved香港成年人接受減重及代謝外科手術及內窺鏡治療的建議準則:香港代謝及減重外科醫學會2024年立場聲明廖玉華、黎敏詩、吳國偉、陳小燕、梁兆基、梅力文、唐琼雄、黃頌德、任寶珠、黃健鴻香港肥胖症的外科治療在過去二十年間迅速發展。儘管大眾對減重和代謝手術的認識和需求不斷增加,但從事減重外科的醫護人員對手術應有的服務模式缺乏統一標準。因此,香港代謝及減重外科醫學會成立了工作小組,審查相關文獻,並就香港成年人
16、進行減重及代謝外科手術及內窺鏡治療的資格標準提供建議。本立場聲明之目的為針對減重手術、代謝手術和減重內窺鏡治療的適應症和禁忌症提供最新指引。Institutes of Health published the first international consensus endorsing the use of gastrointestinal surgery as treatment for severe obesity.8,9 Since then,numerous studies have confirmed the effectiveness of bariatric surgery i
17、n achieving sustainable weight loss and substantial improvement in co-morbidities among obese patients.10 According to a systematic review and meta-analysis of 22 094 morbidly obese patients across 136 studies,bariatric surgery resulted in 61.2%excess weight loss.10 Resolution of diabetes,hypertensi
18、on,and obstructive sleep apnoea were achieved in 76.8%,61.7%,and 85.7%of patients,respectively.10 In a prospective randomised trial of 150 morbidly obese diabetic patients,bariatric surgery plus intensive medical therapy was associated with significantly better glycaemic and metabolic outcomes at 5
19、years compared with intensive medical therapy alone.11 Because bariatric surgery has demonstrated efficacy in treating type 2 diabetes mellitus(T2DM),the term metabolic surgery was established to describe the role of bariatric interventions in treating T2DM and metabolic syndrome.7,16 In 2016,metabo
20、lic surgery was formally endorsed by 44 international diabetes organisations as a treatment option for adults with T2DM and obesity(defined as BMI 30 kg/m2 for Caucasians and 27.5 kg/m2 for Asians),particularly those with co-morbidities which cannot be controlled by lifestyle changes and pharmacolog
21、ical therapy.17 Although operative safety is a concern for morbidly obese individuals undergoing any type of major surgery,current evidence suggests that bariatric surgery has low perioperative mortality rates,ranging from 0.03%to 0.2%.12 In a systematic review and meta-analysis of 161 756 patients
22、undergoing bariatric surgery,the 30-day mortality rates ranged from 0.08%to 0.22%,whereas the postoperative complication rates were between 9.8%and 17.0%.13 Currently,the most widely performed bariatric procedures are sleeve gastrectomy and Roux-en-Y gastric bypass.Common operative morbidities of sl
23、eeve gastrectomy include bleeding,leakage,stricture,and symptoms of gastroesophageal reflux.14 Roux-en-Y gastric bypass is associated with bleeding,leakage,stricture,stomal ulcer,small bowel obstruction,internal herniation,and dumping syndrome.15 Data from randomised controlled trials suggest that s
24、leeve gastrectomy and Roux-en-Y gastric bypass are comparable in terms of 30-day mortality and morbidity rates.15Primary bariatric endoscopic interventionIn recent decades,bariatric endoscopic procedures have been developed for individuals who prefer less invasive,non-surgical alternatives.18 These
25、endoscopic therapies include intragastric space-occupying devices(intragastric balloons IGBs),gastric aspiration devices,endoluminal bypass barrier sleeves,the POSE(primary obesity surgery endoluminal)procedure,endoscopic sleeve gastroplasty,and duodenal mucosal resurfacing.All of these procedures c
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