减重代谢手术患者体质量管理临床路径中国专家共识（2026版）

Chinese expert consensus on the clinical pathway of weight management for patients undergoing metabolic and bariatric surgery (2026 edition)

摘要:

减重代谢手术（MBS）是治疗中、重度肥胖症及相关代谢性疾病的重要手段，但术后仍可能出现减重平台期、复发性体质量增加、营养缺乏及心理行为问题，影响长期疗效与生活质量。目前国内虽已发布减重平台期管理及术后随访相关专家共识，但尚缺乏覆盖术前评估、围手术期管理及术后长期随访全过程的体质量管理临床路径。本共识由中国医师协会外科医师分会肥胖代谢外科综合管理与护理专家工作组组织制定，在系统检索国内外相关指南、共识及循证医学证据基础上，经两轮专家函询和专家论证形成推荐意见，围绕体质量管理的定义与目标、术前评估与强化管理、术后阶段性管理、术后复发性体质量增加的识别与管理、多学科协作与长期随访体系以及患者教育与自我管理六个方面提出推荐意见，构建覆盖“评估-干预-随访-支持”的全周期体质量管理临床路径，旨在为MBS患者的规范化体质量管理提供参考，提高长期减重维持效果及代谢获益，推动我国减重代谢外科体质量管理的标准化发展。

Abstract:

Metabolic and bariatric surgery (MBS) is a key treatment for moderate-to-severe obesity and its related metabolic diseases. However, patients may still experience weight loss plateaus, recurrent weight gain, nutritional deficiencies, and psychological-behavioral issues after surgery, compromising long-term outcomes and quality of life. Although domestic expert consensuses on weight loss plateau management and postoperative follow-up exist, there remains a lack of a comprehensive clinical pathway covering the entire process from preoperative assessment and perioperative management to long-term follow-up. This consensus was developed by the Expert Working Group on Obesity Metabolic Surgery Comprehensive Management and Nursing Support Group, Chinese College of Surgeons. Based on a systematic review of domestic and international guidelines, consensuses, and evidence-based literature, recommendations were formulated through two rounds of expert consultation and discussion. The consensus addresses six aspects: definition and goals of weight management, preoperative evaluation and intensive management, staged postoperative weight management, identification and management of recurrent weight gain, multidisciplinary collaboration and long-term follow-up system, and patient education and self-management. It establishes a full-cycle clinical pathway covering "assessment-intervention-follow-up-support", aiming to provide a standardized reference for weight management in MBS patients, enhance long-term weight maintenance and metabolic benefits, and promote the standardization of weight management in metabolic and bariatric surgery in China.