胃全剔出術後の膵機能 : 特に糖代謝に就いて

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The pancreatic function following total gastrectomy has been investigated by the author with 80 patients submitted to total gastrectomy at the Nakayama's Surg. Dept. (excluding the en masse resection). This study has been conducted for the early post-operative group consisting of 41 cases, the follow-up group consisting of 39 cases, and also for comparison among three different operative modes, namely, esophagoduodenostomy, esophagojejunostomy and jejunum interposed method. The results resolve themselves into the following points: 1) Exogenic Pancreatic Secretion. With 19 cases, three main pancreatic secretory mechanisms after loss of the stomach were evaluated by means of hydrochloric acid, pilocarpin and insulin administration test. The hydrochloric acid and pilocarpin test elicited a reduction in the volume as well as the total enzyme output at the early postoperative date, but showed the approximation to the normal level in the follow-up period. Among three different operative modes, the duodenum passing groups were noted to keep a better function than the duodenum by-passing group. The insulin test, on the other hand, induced no obvious response even after the elapse of three or six-months. 2) Endogenic Pancreatic Secretion. The 50 g glucose administration test revealed an abnormal blood sugar level, with a mean maximun amounting to 180 mg/dl on the discharge in 24 cases, and with that reaching 200 mg/dl during the follow-up period in 25 cases, both of which levels surpass the normal level. Its further analysis was carried out resorting to the glucose double administration test, the glucose intervenous administration test, the insulin and adrenalin test, and various liver function tests. According to the study, such abnormal blood sugar level should be attributable not to the insufficient endogenic pancreatic secretion after loss of the stomach, but to the rapid absorption of glucosides through the intestine as the result of sudden instillation of food into the reridual alimentary tract. The causatives for the higher blood sugar level in the duodenum passing group than in the duodenum by-passing group were also investigated by means of the blood sugar level determination of the drainage vein blood from each portion of the alimentary tract as well as the transition of carbohydrate digestibility along the alimentary canal in our G. I. content analysis study: It was evidenced that the absorption of glucose takes place more prominently toward the upper portion of the alimentary canal and becomes maximum in the duodenum. Judged from the percentage of those survivors who showed normal liver and pancreatic functions, it is stated that the duodenum passing group, whether esophagoduodenostomy or jejunum-interposed mode, is more advantageous than the duodenum by-passing group. Dumping syndrome was most frequently observed in the esophagojejunostomy group. The importance of the fractional dietary regimen is stressed as the most appropriate countermeasure against postgastrectomy diabetes and complaints, and also a dietary table is presented.
千葉大学の論文

胃全剔出術後の膵機能 : 特に糖代謝に就いて

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