胃全剔出術の肝機能に及ぼす影響に就て
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概要
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Those that follow are our conclusion regarding influence on liver function by total gastrectomy in three operative methods, viz., end-to-end esophagoduodenostomy, esophagojejunostomy in the Billroth II fasion and esophagojejunostomy by interposing the jejunum. They are fully based upon preoperative (100 cases) and postoperative, at discharge (55 cases) and at later period (52 cases), examination of liver function in the total gastrectomized patients, and also based upon preoperative evaluation of liver function for surgery and preoperative liver protective medication. 1) Preoperative evaluation of liver function for surgery revealed that those patients with normal or slightly impaired liver function took the better postoperative course. It was also noted that those patients in whom preoperative liver protective medication showed a definite effect to recovery of liver function still reserved an indication for surgery. 2) It has been evidenced that transparietal injection therapy through the splenic vein developed by us is of definite value for preoperative liver protective medication. 3) Infuence of operative intervention on liver function among three procedures was minimum in those patients with end-to-end esophagojejunostomy and maximum in those with esophagojejunostomy by interposing the 'jejunum. 4) In the later period, however, esophagojejunostomy by interposing the jejunum showed the best recovery of liver function, end-to-end esophagojejunostomy in the Billroth II fasion the worst. None of them rendered any serious disturbance of liver function which jeopardized life. 5) The causative factors of differences of postoperative liver function due to operative methods were closely investigated on the basis of analysis of the duodenal juices as well as of roentgenologic examination, by which the degree or mode of mixture of food intaken with the duodenal juices was an important factor of these differences. It is our belief from the standpoint of hepatic condition in the patients undergoing total gastrectomy that esophagojejunostomy by interposing the jejunum is the best, and, if the marked liver damage present, esophagoduodenostomy is the procedure of choice, and esophagojejunostomy in the Billroth II fasion is not recommended except the special circumstances.
- 千葉大学の論文
- 1955-07-28
著者
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